It's Friday, September 26, 2025 and in this morning's issue we're covering: Charlotte light rail killing exposes gaps in NC’s mental health system, Bottlenecks preventing federal Helene relief dollars from reaching those with damaged homes, Autopsy Finds Trey Reed’s Hanging Death at Delta State Was a Suicide; Kaepernick to Fund Private Autopsy, In its battle for water autonomy, Jackson State University pushes plan Jackson, Miss. Water calls ‘engineering malpractice’, North Carolina Cattle Farmer to Pay $92,000 for Damaging Mountain Streams, Medicaid cuts in Idaho could cause dangerous situations, Mass. residents still lean toward in-person care as telehealth booms, Policy requiring Georgia college professors to put their class syllabus online to start in 2026, The cost of child care is hurting working West Virginians. A new program aims to help if lawmakers will fund it.

Media outlets and others featured: North Carolina Health News, Carolina Public Press, Mississippi Free Press, Mississippi Today, Inside Climate News, The Daily Yonder, CommonWealth Beacon, Georgia Recorder, Mountain State Spotlight.

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Charlotte light rail killing exposes gaps in NC’s mental health system

by Rachel Crumpler and Taylor Knopf, North Carolina Health News
September 25, 2025

By Rachel Crumpler and Taylor Knopf

In early September, video of a man stabbing 23-year-old Ukrainian refugee Iryna Zarutska to death on a light rail car in Charlotte shocked the country. People from across the political spectrum demanded answers: How does a horrific, unprovoked attack occur between two strangers? What needs to change so something like it doesn't happen again?

Law enforcement officers say the man was Decarlos Brown Jr., whose criminal and mental health record quickly came under scrutiny. The incident also fueled new legislation by North Carolina’s Republican leaders, intended to be tougher on crime. 

But the new bill — passed easily in both the state Senate and House of Representatives — doesn’t add funding for North Carolina’s mental health system.

Brown, 34, was diagnosed with schizophrenia and living on the streets. Over the past two decades, he’s been arrested more than a dozen times, including several low-level misdemeanors. In 2015, Brown was convicted of armed robbery and served more than five years in prison. During his last encounter with law enforcement in January, when he repeatedly called 911, he reportedly told officers that “man-made” material was inside his body, controlling his actions. 

Brown’s mother says she tried to find him psychiatric help. His sister says if he’d received proper treatment, the killing could have been avoided. Many say Brown should have been locked up — either in a jail or psychiatric facility. The reality is he spent time in both, and he didn’t get the help he needed. 

People with severe mental health disorders often cycle in and out of hospital rooms and jail cells, with little to no mental health treatment in between. Many also struggle with basic needs — housing, employment, access to care — that, if met, would help them be productive and stable in the community.

Mental health experts say they have long been familiar with the fractures and holes in the criminal justice and mental health systems that were exposed by the Charlotte killing. But the general public doesn’t see them until such a tragedy throws the gaps into the spotlight.

“I believe this incident really highlights a systemic failure, not an individual or family failure,” said Kate Weaver, executive director of NAMI Charlotte, an organization that supports people with mental illness and their family members. “When people with serious mental illness don’t receive consistent care, there are risks.”

If North Carolina is serious about finding solutions, advocates say, it will take resources and willpower to overhaul parts of the mental health system that aren’t working and to establish an array of services in the community that actually support people. 

Those resources have not been forthcoming. 

Falling into chasms 

People often first encounter the mental health system during a crisis — either through an arrest or an emergency room visit. In both scenarios, law enforcement officers are typically involved. 

Across the U.S., jails have become de facto mental health facilities. The federal Substance Use and Mental Health Services Administration estimates that 44 percent of people in jails and 37 percent of those in prisons have a mental illness. Jails, in particular, are often ill-equipped to manage people with complex health needs; the costs for managing those mental health issues can be too much for smaller county budgets. 

When someone is brought to an emergency room in a mental health crisis — whether it’s a suicide attempt or a psychotic episode — they are often placed under an involuntary commitment and undergo forced psychiatric hospitalization. By state law, police officers serve involuntary commitment court orders and often transport patients between hospitals, frequently in handcuffs and shackles.

The experience can be jarring, and scarring.

“Transitions in general for all human beings are tough,” said Cherene Caraco, director of Promise Resource Network, a mental health agency based in Charlotte that is staffed entirely by people who’ve had mental health struggles. “And then you’re talking about a transition into an institutional setting and then out of an institutional setting where you are forever changed when your rights are removed.” 

Caraco said most people exit psychiatric hospitals, jails and prisons without follow-up support. “You come out to nothing,” she said.

Ted Zarzar, a psychiatrist who divides his time between UNC Health and Central Prison in Raleigh, said the period where people reenter their communities is high-risk for folks with a mental illness. Their symptoms can spiral downward without continued care. 

Many times these people are released from carceral settings without a job or a place to live. Some people may have a single outpatient mental health appointment scheduled and a 30-day supply of their medications. 

Others might just get handed a list of resources and phone numbers.

“I think it is the exception, rather than the rule, that somebody goes to a follow-up appointment,” Zarzar said. “At best, they end up in an emergency room or inpatient hospital and get connected that way. But at worst, they end up either back in jail or prison, or something horrific happens, like what happened in Charlotte.”

Without a direct handoff to true support and services, it is nearly impossible to stay stable in the community, Zarzar said. People often land right back in a hospital or prison cell in a frustrating — and costly — cycle of recidivism for which taxpayers pick up the tab. Incarceration in a North Carolina prison runs more than $54,000 a year. The average cost of a hospital stay in North Carolina is $2,881 per day, according to 2023 data collected by KFF, a nonpartisan health policy and research organization.

“We don’t have cracks in the system, we have chasms,” Caraco said. “And once you fall into that chasm, it’s not easy to come out of that without a lot of support.”

‘Not a casserole illness’

Lately, lawmakers from New York to California have proposed to involuntarily hospitalize people who are homeless, to force them into mental health treatment. The bill passed by North Carolina lawmakers this week also seeks to push more people into involuntary commitments.

But many in the mental health and substance use treatment community argue that forced psychiatric hospitalization does not  address severe and complex mental illness, and it doesn’t often yield positive results. These commitments are temporary, and people are often discharged without the community support they need. Coerced treatment can also lead patients to distrust the system and leave them reluctant to seek help the next time. 

Bob Ward is a retired attorney who spent a decade representing people in involuntary commitment hearings in Mecklenburg County. Ward said he saw firsthand the lack of treatment and timely care. He said civil commitments of any kind — adult, minor, inpatient or outpatient — are “useless” if the right treatment and supportive services are lacking once the person comes home.

The continuous rise in involuntary commitments — which are intended to be a last resort for someone who is a danger to themselves or others — is a “sure sign of a failed system,” Ward said. A NC Health News investigation found that the number of involuntary commitment petitions filed in county clerk of court offices rose at least 97 percent between 2011 to 2021. 

Only a fraction of those people end up making it through the whole commitment process to a psychiatric inpatient bed, according to a May report by Disability Rights NC. Many who work with people experiencing the process say it’s riddled with problems and needs significant reform. 

Weaver, the NAMI Charlotte leader, said when it comes to involuntary commitment, it’s “difficult to balance people’s rights with public safety, and it is not against the law to have a mental illness.” 

Friends and family also treat mental illness differently than they do other medical issues, Weaver said.

“If you had a loved one with a cancer diagnosis, your friends would rally around you, the casseroles would come, the lawn would get cut and you would have continuing care with a team,” she explained. “When someone in the family has a mental illness, it is not a casserole illness. People don’t come rally around that family, and there is no continuum of care. 

“There is no mental health team that follows that person from the beginning, from illness to wellness.” 

Weaver said families struggle to find lasting help for their loved ones — a situation that played out in the case of Decarlos Brown, the man accused in the Charlotte stabbing.

Brown’s mother said his mental health had declined significantly after his five-year prison stay. By this summer, he only had bits and pieces of mental health support, and he was homeless. 

Lawmakers on both sides of the aisle agree that the system failed Brown. 

“He was failed because his mother wanted somebody to pick him up, and there was not the willingness on the part of the system to do that,” Republican Senate leader Phil Berger told reporters on Sept. 22. “[Iryna Zarutska] was failed because there was a system that would allow someone like that to exhibit the sorts of problematic behaviors without there being any intervention.”

Berger questioned whether inadequate funding for mental health resources was at fault, instead suggesting that people were unwilling to step in with already available resources. 

Solutions include support, more options

In response to the killing, mental health experts who spoke to NC Health News highlighted the need for transitional support for people leaving jails, prisons and psychiatric facilities. They also emphasized the need for money for an array of community mental health services that could prevent stays in jails and psychiatric facilities, which are expensive and often the least effective option.

The mental health system is designed to take a faulty approach with limited options, said Caraco, director of Charlotte’s Promise Resource Network.

“You do this, and then you do this, and then you do this. You need a referral. You need an assessment. It is time-limited. You need a diagnosis. You have to comply with medications,” she said. “All of the things that lead people to not being able to engage in anything that feels meaningful.”

There’s a predetermined set of services and options. Either it works for people, or they walk away, she said. 

Caraco said her organization ends up serving many of those who’ve walked away from traditional mental health care that they found ineffective or harmful.

“Our system should be set up like a buffet. There are times where you want nothing but crab legs, and there are times you’re going to eat dessert first, but you have an array of options available in front of you to choose from. Because at different times, different things feel right,” she said. “That array has got to be accessible to you.”

Caraco believes that connecting people with certified peer support specialists at hospitals or jails would help bridge some of the gaps. Peers draw on their own experiences with mental illness, substance use, homelessness and/or incarceration, making them more relatable to people navigating the same challenges.

Hospital emergency departments already employ people who are often referred to as “sitters,” whose role is to sit with patients at risk for suicide to make sure they are safe. Caraco suggested that hospitals replace sitters with community-based peer support specialists. 

“They’re sitting in the emergency department. They’re interacting, they’re developing plans, they’re getting deeper into the relationship and what’s going on,” Caraco said. “And trying to establish that rapport and that relationship right off the bat.” 

If these people were peer support specialists from a community-based organization, instead of hospital employees, that relationship could continue after the patient is discharged. Some psychiatric hospitals use “peer bridgers” who build relationships with people while they’re still inpatients, with the goal of staying connected once the patient is released and navigating the community mental health system. 

That same concept can also be applied to jails and prisons, Caraco said. 

Peer support specialists and social workers are being incorporated into mental health crisis responses more often. Initiatives like the HEART team in Durham use a mental health crisis response unit to respond to 911 calls related to mental illness, homelessness and substance use. These specialized teams can help steer people to community support instead of emergency rooms or jails.

“We need folks who have lived experience — not only of mental health disabilities, but of criminal justice involvement and incarceration, because no one wants to talk to people who can’t relate to them,” said Corye Dunn, policy director with Disability Rights NC.

Bring care to where people are 

Dunn said there’s also an opportunity to bolster Assertive Community Treatment teams, which are designed to be community-based, wrap-around services for people with severe mental illnesses. She suggested there should be more forensic ACT teams that include peer support specialists who were previously incarcerated. 

Zarzar said ACT teams break down barriers to accessing care by bringing it to people where they are — even if it’s under a bridge. 

“It takes the inpatient treatment team and puts it on the outside,” he said. Teams include psychiatrists, nurses, peer support specialists and more. They have frequent contacts with clients to help get their basic needs met and reach their personal goals.

Zarzar said he’s seen positive outcomes, but it hinges on a person’s voluntary participation.

Clinical social worker and longtime mental health advocate Bebe Smith said it can be difficult for people to qualify for ACT team services, as they have to fit narrow criteria of a diagnosis of severe and persistent mental illness plus a high utilization of services. 

They must also have Medicaid and be enrolled in one of North Carolina’s  “tailored” plans.

According to the N.C. Department of Human Services, North Carolina operates 87 ACT teams — a number that has remained relatively stable over the past decade. Between 6,400 and 6,800 individuals received ACT services at any given time last year. In fiscal year 2024, the state spent $8 million in non-Medicaid funds to cover treatment for uninsured individuals, supporting 915 people.

Seven ACT teams serve Mecklenburg County, six of which are open to new referrals with no waitlist, according to DHHS. The Assembly reported that Brown was working with an ACT team for at least some of last year, though it’s unclear if he still was getting services at the time of the light rail murder.

In fiscal year 2025, ACT participants statewide saw a 19 percent decrease in emergency department use and a 2 percent reduction in homelessness, according to data DHHS provided to NC Health News.

However, Smith said that the quality of services can vary across ACT teams. While it’s supposed to be intensive, wrap-around care, sometimes all that is provided to the patient is “a brief touch or medication delivery,” she said.

Opportunities during reentry 

Many people with complex mental health needs end up in the most expensive settings — hospitals, jails, prisons. 

System experts see an opportunity to interrupt how people cycle through them by investing more in reentry supports that will allow people to land — and stay — on their feet in the community. 

Zarzar, the psychiatrist treating people in the community and in prison, said he often sees people bounce between those settings.

That’s driven his work as the director of FIT Wellness, a program for people with a serious mental illness leaving the state prison system or jails. FIT Wellness provides psychiatric and physical health care — along with connections to community support like housing and transportation — to people in Wake, Durham, Orange and New Hanover counties.

The program employs formerly incarcerated people trained as community health workers to work with people being released from incarceration. A team member will meet with a person before they are released to discuss their needs and establish a pathway to care. 

“Thus far, we’re having a lot better success at getting people to come in to that first appointment,” Zarzar said. “It still can fall apart after that, but during this high-risk, high-needs period — that first month or so after people get out — we’re doing a better job in terms of getting people to come.”

Along with addressing mental health needs, advocates say investment in meeting people’s basic needs — housing, food, work or school — could help reduce recidivism. Data shows that about two-thirds of unhoused people also have mental health disorders.

“We are responsive after the fact, and so we’re often willing to invest in things like harsher prison terms. But again, that’s not going to prevent the new person from engaging in some act,” Apryl Alexander, director of UNC Charlotte’s Violence Prevention Center, said. “I’m waiting for the time that we get invested in putting our money into prevention. 

“If we take care of basic needs, we see all of this [criminal involvement] reduced.”

The barriers to housing are many, but groups like Queen City Harm Reduction in Charlotte are piloting Housing First programs with success. These programs help people navigate the barriers to housing — like evictions or criminal records — that many people living on the streets face. The program uses case managers to help find flexible landlords, track down necessary documentation and secure a rent deposit. The program doesn’t require someone to be abstinent from substances to qualify for housing. Program director Lauren Kestner has found that many people who find employment and get housed wind up reducing their drug use. 

Mecklenburg County Sheriff Garry McFadden said it costs $198 a day to house someone in Mecklenburg’s detention center. He contended that those funds might be better spent on early intervention mental health treatment and reentry support to help reduce people’s recidivism. 

Harold Cogdell Jr., a Charlotte defense attorney and former assistant district attorney at the Mecklenburg County District Attorney’s Office, said better supporting people before a crime occurs is a better approach than “paying on the back end.”

“There is a victim, so the harm has been done,” Cogdell said. “If we focus more on making a person holistically healthy on the front end, that increases the likelihood that … the crime may never be committed.”

‘We have to do more’

“The state has an obligation to build systems that make sense, and this does not make sense,” said Disability Rights’ Dunn. “[The system is] very convoluted. It is a one-size-fits-all approach that is going to increase demand without improving outcomes, on the mental health side at least.”

For decades, the state shuttered state psychiatric hospitals with promises to spend the savings on community resources that never materialized. Many say this contributed to the dearth of services seen today. 

A decade after the closure of the state’s largest psychiatric facility, Raleigh’s Dorothea Dix Hospital, an infusion of $835 million into behavioral health came from Medicaid expansion sign-on bonus. That money has allowed the state to catch up some, raising rates for providers and investing in mental health crisis services, pre-arrest diversion programs and more.

State health officials have allocated $99 million to boost services specifically for people in the justice system.  

The additional funding has allowed North Carolina to improve some metrics, such as increased state psychiatric bed availability, decreased emergency department use for mental health holds, and fewer people in jails and prisons with mental health diagnoses, according to DHHS.

But, in a statement to NC Health News, the state health department acknowledged there’s more to be done to support people with mental health and substance use issues as they leave jails and prisons.

“Upon their release from incarceration, we have to do more to protect both their success and public safety,” the department said in a statement to NC Health News. 

The reality, though, is that the bill passed by state lawmakers this week in response to Zarutska’s death did not add any funding to bolster the mental health system.

That, along with uncertainty looming from cuts to Medicaid funding as part of President Donald Trump’s One Big Beautiful Bill, could put much-desired changes increasingly out of reach.

“We can’t ignore the fact that we haven’t invested in mental health services,” Weaver, the NAMI Charlotte leader, said. “As a country, we’ve taken away more and more mental health support, and with the looming Medicaid cuts coming, as an organization, we’re bracing ourselves for a lot more people being uninsured, unable to access resources and struggling even more.” 

This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Bottlenecks preventing federal Helene relief dollars from reaching those with damaged homes

by Lucas Thomae, Carolina Public Press
September 25, 2025

Tens of thousands of people displaced. More than 70,000 damaged homes. Tropical Storm Helene rendered much of Western North Carolina’s housing supply uninhabitable, and many storm survivors continue to wait for the day they can move back into their homes.

While the state and federal governments have made strides in clearing debris and repairing infrastructure across the region, getting residents back into permanent housing has proven to be one of the most difficult aspects of the long-term recovery process.

There’s been progress, but approval of rebuild plans and distribution of funds has been “painfully slow,” particularly at the federal level, according to Matt Calabria, the governor’s chief advisor for Helene recovery.

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FEMA’s Hazard Mitigation Grant Program, the federal program which provides money for home buyouts and elevations, has yet to approve funding for a single project in North Carolina.

“We have applications for home buyouts and elevations that were submitted to the federal government as long ago as February. To date, no damaged homes have been approved for the HMGP program,” Calabria told state legislators at a committee hearing on Wednesday.

“What that has meant is literally hundreds of families that are held in limbo, maybe paying mortgages on damaged houses and (who) are being held in abeyance right now, are waiting to see what the determination on that application is.”

Calabria leads the Governor’s Recovery Office for Western North Carolina (GROW NC), which oversees the statewide recovery effort and coordinates response between all levels of government and non-government partners.

His office holds regular briefings with state legislators and North Carolina’s Congressional delegation, often advocating for increased and expedited funding for rebuilding of damaged homes and other needs.

“GROW NC was designed to be the nerve center for Helene Recovery,” Calabria told Carolina Public Press in an interview.

So far, state and federal contributions fall far short of the estimated $60 billion cost of recovery. The state government has put forward $3.1 billion thus far, while the federal government has awarded the state $5.2 billion.

Analysis from the Office of State Budget and Management estimates that insurance companies and other nongovernment entities have paid about $7 billion of the estimated cost of recovery, leaving about $45 billion in unfunded needs.

Last week, Gov. Josh Stein traveled to Washington, D.C., to advocate for a new federal funding request worth $23 billion, $13.5 billion of which is new funding that Congress would need to pass.

This request, Stein argued, would put the federal government’s share of recovery costs in line with previous major storms. President Donald Trump’s administration has been reluctant so far to approve new spending for disaster relief.

Just how little of the already-promised federal money that’s been dispersed is another problem. So far, a little more than $800 million of the $5.2 billion awarded by the federal government has actually been received by the state.

Calabria warned legislators that a “bottlenecking” of federal money is slowing down recovery efforts, including efforts to rebuild or replace damaged homes.

Part of the issue is a new federal policy that requires Secretary of Homeland Security Kristi Noem to sign off on every department expenditure over $100,000, including FEMA funds. Local governments have already raised concerns that they have not received expected reimbursements from FEMA for things like debris removal.

As for the expected funds from other government agencies, the processes for drawing down that money is simply not designed to happen quickly.

For example, the $1.4 billion awarded by the Department of Housing and Urban Development (HUD) for the state-run home repair and rebuilding program has yet to hit the state coffers. That program, branded Renew NC, is currently running off a $120 million allocation from the state legislature.

As of Wednesday, more than 3,300 households with damaged homes have submitted applications for Renew NC’s single-family housing program.

Applications for the single-family housing program will remain open until December. Renew NC hasn’t begun accepting applications for its forthcoming multi-family housing and workforce housing for ownership programs.

In late August, the state completed its first repair project for a home in Fletcher, a town in Henderson County just south of Asheville.

“It feels real good to be back home,” homeowner Matalene Waters said in the state’s press release announcing the milestone.

Four more houses are nearly ready to begin construction, while another 631 applicants have been approved for the program and are currently undergoing the pre-construction assessments required by HUD.

Stephanie McGarrah, the Department of Commerce official who leads Renew NC, told CPP that her soft goal for the single-family housing program is to repair or rebuild 3,000 damaged homes. McGarrah estimated that a majority of the approved applicants will require a full rebuild rather than just repairs.

She expects the first full-rebuild project can be completed by January.

McGarrah said she’s confident that the money set aside for the single-family housing program will be enough to meet that 3,000-home goal. However, completing that work in a timely manner is the real challenge.

For those with damaged homes, accepting federal money comes with lots of red tape. The state must comply with more than 15 laws before proceeding with a project.

That process involves checking that the applicant meets the eligibility criteria, then conducting a damage assessment and a thorough environmental and historic preservation review.

HUD also requires a check for duplication of benefits, meaning if an applicant previously received funds for home repairs or assistance they must pay that money back before proceeding with the program. That’s unfortunately a deal-breaker for some applicants, McGarrah said.

Some nonprofit and volunteer organizations have provided an alternative to the government-run rebuild and repair programs. These organizations tend to work quicker because they have few regulations that they must follow other than obtaining permits and following building codes.

“I want us to hurry more than anybody, but we don't have the luxury that a nonprofit has,” McGarrah said.

State leaders praised some of these organizations for their charitable work following Helene and have worked to build partnerships with them.

The state legislature provided funding worth $28 million to organizations like Habitat for Humanity and Baptists on Mission to support their rebuilding projects. To date, they’ve repaired or rebuilt more than 500 damaged homes with the help of state dollars.

Other organizations, such as Samaritan’s Purse, turned down the government money because they felt it would slow their efforts down. So far, the Boone-based humanitarian aid organization has rebuilt more than a dozen damaged homes in the area.

Disaster relief is a patchwork of many different initiatives, state leaders have emphasized, and it will require ongoing collaboration between both government and non-government entities to get Helene victims matched up with the appropriate program to meet their needs.

The unfortunate truth is that no time goal is quick enough to transition people back into permanent homes.

“We know it's gonna take everybody,” McGarrah said.

“And it's gonna take a long time, and I wish that weren't true.”

This article first appeared on Carolina Public Press and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Autopsy Finds Trey Reed’s Hanging Death at Delta State Was a Suicide; Kaepernick to Fund Private Autopsy

by Nick Judin September 18, 2025

Trey Reed Hanging Death Was Suicide, Officials Say; Kaepernick to Fund Private Autopsy

Delta State University student Trey Reed’s death was a suicide, Cleveland Chief of Police Travis Tribble said, announcing the results of an autopsy.

Mississippi Free PressNick Judin

Delta State University student Trey Reed’s death was a suicide, Cleveland Chief of Police Travis Tribble said on Thursday afternoon, announcing the results of the autopsy on the 21-year-old student, who was found hanging in a tree in the middle of campus on Monday, Sept. 15.

“On September 17, 2025, the Mississippi State Medical Examiner’s Office conducted an autopsy. Findings were consistent with the initial investigation, determining the cause of death to be hanging and the manner of death as suicide. Final toxicology results are pending and may take two to four weeks to complete,” the statement said.

Additionally, Tribble said that “as part of the investigation, all files and investigative material have been turned over to the Federal Bureau of Investigation and the U.S. Attorney Office for review.”

The findings of the Mississippi State Medical Examiner’s office are consistent with the initial findings of the Bolivar County Coroner’s Office, which found no wounds on the body of Reed at the time of his discovery that would indicate foul play.

Friday morning, after this story was first published, WJTV reported that Colin Kaepernick’s Know Your Rights Camp’s Autopsy Initiative will pay for the costs of a second autopsy after the state medical examiner releases Reed’s body.

“Trey’s death evoked the collective memory of a community that has suffered a historic wound over many, many years and many, many deaths,” wrote Attorney Benjamin Crump. “Peace will come only by getting to the truth. We thank Colin Kaepernick for supporting this grieving family and the cause of justice and truth.”

Reed’s death has set off alarms nationwide, with numerous civil rights activists, lawyers, and political figures demanding a full and independent investigation into the young man’s death. Reed’s family, represented by Jones Law Firm attorney Vanessa J. Jones, will be seeking both an independent autopsy and an independent investigation into his demise.

“Our thoughts and prayers remain with Reed’s family and friends during this very difficult time. We want to encourage anyone who is struggling to reach out for help,” Tribble wrote.

Mississippi Department of Public Safety Commissioner Sean Tindell also responded to the autopsy results.

“My condolences go out to the family of Trey Reed and all who knew and loved him,” he said. “I also applaud the quick work by the Cleveland Police Department, the Mississippi Bureau of Investigation, and Delta State University to bring closure to his family, and I condemn the rumors circulating regarding his death.”

Read more of the Mississippi Free Press’ coverage of Trey Reed’s death here.

In its battle for water autonomy, JSU pushes plan JXN Water calls ‘engineering malpractice’

by Molly Minta, Mississippi Today
September 19, 2025

In the latest twist in Jackson State University’s quest to insulate itself from the city’s water woes, testimony before U.S. District Judge Henry Wingate revealed that a years-in-the-works, nearly complete plan to install backup water tanks on campus could put students at risk of consuming water not intended for drinking. 

But the historically Black university, which has not been involved in the city’s ongoing lawsuit until now, was not forced to court over the issue. Instead, the university was the one that filed a grievance. It sought Wingate out for help with what it described as an insurmountable roadblock: Ted Henifin, the federal water receiver, who was refusing to permit the project to move forward. 

“It has an enrollment effect on us, a morale effect on us, and most important, an operational effect on us,” Vance Siggers, the director of campus operations, told Wingate, adding that each time the university experiences days without water, it loses “somewhere between 50 and 100 students just on the basis of we don't have water on campus." 

The two sides mostly talked past each other during the Thursday proceedings, with Jackson State contending that it was not attempting to build its own water system for human consumption. The university has been working on this project since the 2022 water crisis disrupted the fall semester for weeks. 

Henifin, backed by testimony from the Mississippi State Department of Health, responded that the university’s plan for the backup tanks did not follow safety regulations. That’s in part because, during emergencies, health officials said the plan would route nonpotable water through the same pipes the university normally uses to deliver potable water to the kitchen and dormitories. 

“Looking back, it would have been great to work with them from the very beginning,” Henifin said. “At the end of the day, Jackson State hired an engineering firm and they should have reached out to the health department. … It’s engineering malpractice that they got this far along.” 

Wingate began the proceedings by reading aloud a Sept. 11 letter he received from the university’s lobbyist. The letter described how Jackson State has a looming deadline to spend $8 million in pandemic relief funds administered by the Department of Finance and Administration to install four water tanks on its campus as part of a plan designed by a local contractor, the Pickering Firm. 

Those tanks, which can’t be returned, are currently sitting unused on state property because Henifin will not sign a document that the Mississippi State Department of Health needs in order to formally review Jackson State’s plans. 

Instead, the letter portrayed Henifin as pulling strings with the health department to block the project. JSU claimed Henifin had wrongly surmised that the university was attempting to build its own water system. 

“Our goal is not to create a new water system but to ensure access to backup water tanks to prevent our students from experiencing water shortages,” Jacqueline Anderson-Woods wrote to Wingate, hoping the plea would lead the judge to force JXN Water’s approval

Over the next three hours, Wingate attempted to unpack the disagreement, an effort that involved testimony from Henifin, Siggers and Bill Moody, the director of the health department’s public water supply division. 

The university argued it does not want to build an independent water system and will continue to draw from the city’s water system and pay its bills. 

“This is not an independent water system, this is a backup water system,” Siggers said. “We still have to cut those 18 payments a month that I will sign off on every month.” 

Siggers described what he envisioned: During periods when issues with the city’s water system resulted in low water pressure on campus, the university could trigger the backup water tanks to keep its cooling and heating systems going.

Students could use the backup water to flush toilets and shower so they did not have to leave their dorms to use portable toilets, such as during the 2022 water crisis. Dining hall staff could continue to use the water to keep the kitchen clean. 

“It is important that we keep a certain level of PSIs on campus for student use in residence halls such as flushing toilets, shower needs, and washing,” he said. “Over in the dining facility, it is used for back-up such as maintaining cleanliness in the dining facilities while we serve our students.” 

When the university reached out to Henifin after learning he was blocking the project, Siggers said they did not receive a response. Henifin even ignored a letter from Alfred Rankins, the commissioner of the university’s board, the Institutions of Higher Learning, in support of the project. 

In response to Siggers’ testimony, Henifin told Wingate he was “very confused” because as far as he knew, there was no way in the proposed design for the university to separate nonpotable water that goes to a shower from potable water that goes to a bathroom sink. 

“They don't have a dual-pipe system where they can put nonpotable water into their system and only go to toilets for flushing,” Henifin told Wingate. “If it goes into a shower, people open their mouths when they shower.  Nonpotable water is not allowed to be used in showers in buildings.”

Henifin also noted that if Jackson State is storing unused water in these tanks for months, bacteria or other contaminants are likely to grow. That means if there is a possibility students could consume the water, the university must treat it — which requires obtaining the necessary regulations, hiring a water operator and conducting regular testing. 

“As the protector of Jackson’s water … I cannot sign off on anything that may cause people to have contaminated water,” he said. 

The first Henifin learned of the project was when the contractor reached out to ask about an “infrastructure tie-in,” he said.  He added that he thought improvements JXN Water had made to the city’s delivery system, including winterizing its facilities, meant Jackson State no longer needed to pursue this project. 

This testimony led Wingate to call on the Mississippi State Department of Health. Moody, the director of the department’s bureau of public water supply, told Wingate he had determined that regardless of university’s intent, it was seeking to build a system intended for “consumptive” use. 

Moody had informally reviewed the plans, which the university had not provided to him until he issued a cease-and-desist order on the project in May. 

“The plans that I’m looking at fully indicated the water would be flowing into the tanks and flowing back out into the building using their pipes,” Moody said. 

Moody added the university could solve this if it routed the water from the tanks solely to mechanical systems like HVAC, so that students do not risk consuming the nonpotable water. 

Another solution would be for the university to become a public water system, a legal designation for a system that delivers drinkable water to more than 25 people for at least 60 days out of the year. 

But Jackson State kept reiterating to Wingate that it did not want to become a public water system because it did not intend for students to drink its backup water, despite the testimony from the health department that its plans would result in students consuming nonpotable water. 

“This goal is to be achieved by installation of above ground tanks on the customer side of existing taps to distribute water to dining services, campus housing, the student health center,” said Monica Davis Allen, an attorney for the university. “The intention is to ensure continuous campus operation and not for human consumption.” 

At the end of the proceedings, Wingate asked Jackson State to submit a brief to the court within five days as to whether it was building a public water system.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

North Carolina Cattle Farmer to Pay $92,000 for Damaging Mountain Streams

Wildlife officials had to rescue, relocate brook trout after Bottomley Properties cleared hundreds of acres of mountain forest for grazing.

By Lisa Sorg

September 19, 2025

This article originally appeared on Inside Climate News, a nonprofit, non-partisan news organization that covers climate, energy and the environment. Sign up for their newsletter here.

ALLEGHANY COUNTY, N.C.—One of the most prominent cattle farmers in North Carolina has reached a financial settlement with the state Department of Environmental Quality over allegations that its grazing operations damaged more than three miles of mountain streams and prompted state wildlife officials to conduct an emergency rescue of a fragile species of brook trout from the waterways.

The Sept. 4 settlement with Bottomley Properties and related companies ends a protracted legal battle that, in part, hinged on a technicality over which DEQ employee was authorized to sign the civil penalty assessment.

It reduces the original civil penalty from $263,000—one of the largest ever assessed by DEQ—to $92,500, payable in installments over four years. It stipulates that neither side admits to violations or errors.

DEQ declined to comment on the settlement. An attorney for the Bottomley Properties did not respond to a request for comment.

A spokesperson for the conservation nonprofit group, Blue Ridge Trout Unlimited, in Winston-Salem, praised the settlement. “Bottomley raised very aggressive arguments in the litigation which, had they been successful, would have undermined DEQ’s ability to protect trout streams moving forward. Hopefully, the fine plus several years of litigation will encourage other actors to abide by our laws intended to protect trout populations.”

The Bottomley family farms more than 55,000 acres in the mountains of North Carolina and Virginia, where it raises 17,000 beef cattle, as well as pumpkins, watermelon, Christmas trees, kale and other produce.

In June 2020, the farm began clear-cutting 360 acres of mountain forest to expand its cattle grazing operations. That October, inspectors with the state Division of Water Resources followed up on a complaint and found 1 to 3 inches of dirt in a stream that feeds Ramey Creek, which is classified as high-quality water for trout as well as a water supply for communities downstream.

DEQ recommends that farmers leave a 25-foot buffer of vegetation between fields and waterways to prevent sediment and waste from entering them. However, state law exempts agriculture and mining operations from buffer requirements; Bottomley cut right up to the stream banks, which eroded and sloughed into the waterways, the state found.

In addition, inspectors later found the cattle grazing operations had polluted a stream with high levels of fecal bacteria, more than six times the state freshwater standard, state records show. 

Experts hired by Bottomley Properties testified that the bacteria could have originated from failing septic systems, but “provided no evidence,” according to court documents.

Bottomley Properties did not correct the earlier violations, according to state records, and the runoff continued. In June 2021, heavy rain dislodged sediment from the scoured hillsides and deposited dirt into five streams, at depths ranging from 3 inches to 2 feet, court records show. 

The sediment also entered two wetlands, covering roughly three-quarters of an acre.

“The violations observed constituted some of the most extensive sedimentation damage to waters the Division of Water Resources staff involved in this matter have ever seen,” state documents read.

The damage violated the state’s “other waste standard” that prohibits sediment and other substances from impairing waterways.

Company official Mitchell Bottomley contended in his court filing that the sediment in this case was not “other waste” because he “values his soil.” A judge found the claim lacked merit.

The layers of dirt also threatened the habitat of a fragile species of fish, known as a brookie, or Southern Appalachian brook trout. Only about 6 inches long, they are too small to eat. They live only in the cold, clear headwaters of mountain streams. Studies have shown the fish are under stress due to rising temperatures caused by climate change.

Over just two weeks, before and after the heavy rain, state Wildlife Resources Commission (WRC) officials found the number of brookies in Ramey Creek had declined by two-thirds—a “worst case scenario,” court documents show.

WRC quickly collected as many brookies as possible and relocated them to a different mountain stream, where they survived. 

However, over 18 months, the number of brookies in the stream near the clear-cut site decreased from 20 to zero, WRC officials testified.

At the time, an attorney for Bottomley Properties disputed many of the allegations, and later appealed the judgment in the state Office of Administrative Hearings. At the OAH, an administrative law judge hears civil disputes between a state agency and a person or business in a contested case hearing.

In court filings, the company’s attorneys wrote, ”the case is about misguided bureaucratic fervor directed at farmers and their lawful activities in order to produce unlawfully inflated penalties.”

They argued that state regulators acted “erroneously, and was arbitrary and capricious” in how they assessed many of the environmental damages.

In May 2023, Administrative Law Judge John Evans, a former DEQ chief deputy secretary under former Republican Gov. Pat McCrory, vacated the civil penalty assessment on the grounds that the wrong DEQ official signed the document. Evans did not rule on the merits of the allegations.

Four months later, DEQ reissued the penalty, which Bottomley attorneys again appealed to the OAH. The case went to trial, and Judge Evans reduced the penalty to $184,000. Both parties appealed the decision to a Superior Court. Earlier this year, the court sent the case to mediation, which resulted in the settlement.

Companies owned by the Bottomley family have a long history of environmental and labor violations. One enterprise, Glade Creek Dairy in Alleghany County, racked up dozens of state environmental citations and more than $15,000 in fines, according to DEQ records. From 2003 to 2016, Glade Creek Dairy was cited for overflowing manure pits, illegal application of the waste on land, discharges from barns into streams, and failures to pay annual permit fees.

North Carolina Cattle Farmer to Pay $92,000 for Damaging Mountain Streams - Inside Climate News

Wildlife officials had to rescue, relocate brook trout after Bottomley Properties cleared hundreds of acres of mountain forest for grazing.

Inside Climate NewsLisa Sorg

‘You’re Going to See Very Severe Things and Dangerous Things’: Medicaid Cuts in Rural Idaho

by Madeline de Figueiredo, The Daily Yonder
September 22, 2025

In the early hours of the morning, Amy Klingler, a primary care physician assistant in Stanley, Idaho, answered a call from a panicked patient. The woman was experiencing severe lower abdominal pain and had been vomiting for hours. She said she feared she might be suffering from an ectopic pregnancy—a serious, potentially fatal condition. But even in that moment of crisis, the patient hesitated to seek emergency care.

“She was calling me at three o'clock in the morning wondering what to do. She didn't really want to go to the emergency room,” Klingler said. “She'd been sick for several hours and hadn't gone because she didn't have insurance. And then, of course, the fears about reproductive health care in Idaho.” 

Klingler said that while treatment of ectopic pregnancies is legal in Idaho, concerns about access to reproductive care often cause patients to delay both preventative and emergency treatment. 

“That was another really heartbreaking thing for me, that this person was in pain, throwing up for several hours, was afraid to go to the ER, was afraid about the bill from the ER.”

Eventually, the patient sought emergency medical attention and was treated for appendicitis. 

Since the Supreme Court overturned Roe v. Wade in 2022, Idaho has enacted one of the strictest abortion bans in the country. Physicians can face felony charges and prison time for providing abortion care. A July study found that, following the implementation of the abortion ban, Idaho lost 35% of its OBGYN providers, worsening the landscape of maternity care deserts and further straining access to care.

Maternity care deserts are counties with no hospital or birth center offering obstetric care and no obstetric clinicians. According to data collected by March of Dimes, 32% of Idaho’s counties are maternity care deserts. 

Now, those pressures are expected to deepen. The federal budget reconciliation bill, passed by Congress in July, significantly tightens Medicaid eligibility and benefits by adding work requirements, more frequent income checks, cost-sharing, and restrictions on non-citizens. Providers said these changes are already creating hurdles and could lead to major coverage losses and reduced access to care.

As providers race to keep pace with increased patient volume, more emergencies, and changing insurance coverage, the new federal policies threaten to exacerbate provider shortages, erode access, and deepen fear around seeking health care. 

Barriers to Access

Idaho expanded Medicaid in 2020 after voters approved a ballot initiative, extending health coverage to an additional 90,000 Idahoans, bringing the total enrollment to around 355,000 adults and children. But now, both state and federal policymakers are rolling back parts of that expansion. 

The budget reconciliation bill introduced major changes to Medicaid, including requiring expansion enrollees to recertify eligibility every six months, a shift that could trigger significant coverage losses due to administrative hurdles. It also imposed work requirements, cost-sharing, limits on non-citizen coverage, and tightened eligibility rules. Preliminary estimates suggest 40,000 Idahoans could lose Medicaid, while another 35,000 could lose marketplace insurance.

Klingler is already seeing the consequences of the recertification process play out with her patients. 

“The administrative burdens and the recertification burdens are what is going…to really impact people,” she said. “I have had patients in the last month try to recertify and run into barriers.” 

Anthony Wright, executive director of Families USA, a nonprofit advocacy group focused on affordable, high-quality health care for all Americans, said that the cuts to Medicaid will affect both patients and health care systems. 

“The cuts to Medicaid and the ACA will have devastating and dramatic impacts on health coverage, care, and costs for American families, and in many ways especially in Idaho. The cuts will not just mean that tens of thousands of Idaho residents lose coverage, but federal cuts will force state budgets into crisis, forcing states to drastically scale back services, leading to closures of rural hospitals and community clinics,” said Wright in a statement.

Clinicians are bracing for these impacts. 

“We anticipate a lot more uninsured people over the next several years because of Medicaid funding loss and Medicaid expansion restrictions,” Klingler said. 

Dr. Brenna McCrummen, an OBGYN in Kootenai County, has already witnessed the impact of worsening maternity care deserts. Bonner General Health, the only hospital with OBGYNs in Bonner County, located directly north of Kootenai County, closed its obstetrics services in 2023.

All four OBGYNs from Bonner County told NBC that Idaho’s strict abortion laws influenced their decision to leave. As a result, patients now have to travel hours for care, including to see Dr. McCrummen.

“We have patients who drive two to three hours to come see us for prenatal appointments and to deliver in Kootenai County,” Dr. McCrummen said. “It's quite a lot and some of them don't have transportation."

Dr. McCrummen said that many of her patients are covered by Medicaid, including those that travel from Bonner County. 

“The Medicaid population is large, especially in the rural areas that we take care of to the north,” she said. “They have already been kind of displaced in terms of not having providers close to their home. And so in addition now to traveling far to come see us, those who will no longer be on Medicaid find many different barriers to care.”

Spikes in Emergency Care

Dr. McCrummen said that when people lose insurance coverage, it adds to the barriers they already face in accessing care, particularly in rural areas. These compounding obstacles often lead patients to delay treatment, turning manageable health issues into emergencies.

“They're already traveling, they're already disadvantaged, and now you've just delayed their care even more. And delaying their care, of course, can make problems worse by the time they get to us,” Dr. McCrummen said. “There are more ED visits, their problems are worse because they haven't been cared for as they should have been, and they have bad outcomes because they're further disadvantaged from seeking care.” 

These delays, she explained, extend far beyond just obstetrics situations and affect every aspect of women’s health.

“Pap smears, preventative care, birth control, STI testing, all of those things are going to be harder to get,” she said. 

Without access to routine screenings and evaluations, Dr. McCrummen warned, common conditions can escalate into dangerous health crises.

“[For example], women who have abnormal bleeding and can't be seen or evaluated can then become very anemic and it's very dangerous,” Dr. McCrummen said. “So it absolutely impacts not just obstetric care, but all of women's health care across the board.”

In Stanley, Klingler counsels her pregnant patients on acquiring insurance for emergency medical flights. 

“We have a couple pregnant people in the community right now, and one of them is set to deliver in March,” Klingler said. “She saw the OBGYN for her first visit recently, and I was reading the notes, and he was already talking about, okay, you need to have air ambulance insurance.” 

Klingler said two air ambulance services operate in the area, and residents can purchase memberships for coverage.

“We encourage everyone, really, in our community to have that [membership],” Klingler said. “If you do get a helicopter ride out of our community, those helicopter rides are probably anywhere from $25,000 to $50,000 if you were to have to pay out of pocket. Health insurance does cover those emergency flights, but even a 20% copay on that can be really impressive and difficult.”

“It's all the conversations that we have to have. And then with challenges in health care, with some of the restrictions in Idaho, those things have become even more important,” she said. “So the smaller communities are really being hit the hardest.”

Risks to Providers

The penalties for providing abortion care in Idaho are among the harshest in the country, prompting many physicians to leave the state and deepening an already growing provider shortage. 

Amber Nelson, executive director of the Idaho Coalition for Safe Healthcare, clinician-led group advocating for safe, legal, and evidence-based medical care in Idaho, said the state’s laws are forcing doctors to choose between legal compliance and best medical practices.

"Right now, in this state, our providers have to choose to follow the law or follow medical standards of care,” Nelson said. “And if they choose medical standards of care, they can be threatened with criminal activity. They can be fined, they can be imprisoned. They can have their medical licenses taken away from them, which makes it a less-than- friendly place to practice medicine." 

Providers say that Idaho’s hostile legal climate is already discouraging new physicians from practicing in the state, and with patient volume on the rise, upcoming Medicaid cuts are expected to make recruitment and retention even more difficult.

“As we see increased volumes, we're not going to be able to add providers to help take on those volumes,” Dr. McCrummen said. “When you criminalize medicine, people are hesitant to practice in a state like that, and now these Medicaid cuts are going to even worsen that.”

“You're going to see very severe things and dangerous things,” Dr. McCrummen said. “So all of those things combined to make it very difficult to get providers to come work in Idaho.”

“Who wants to move to a state that doesn't provide care to their patients?”

This article first appeared on The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Phoning it in – Mass. residents still lean toward in-person care as telehealth booms 

by Jennifer Smith, CommonWealth Beacon
September 25, 2025

AS THE COVID-19 pandemic surged, homes became workplaces, schools, and day care centers. And with the rise of telehealth, they became remote doctors’ offices too.  

Now half a decade from the first lockdowns, most major providers offer telehealth options, but new polling finds nearly two-thirds of Bay State residents are still primarily receiving their health care the old-fashioned way: in person. 

Telehealth involves a clinician providing a patient medical services, in real time or asynchronously, generally by phone or video conferencing. While technological developments like laptops and cell phones made the practice more convenient in recent decades, KFF research in March 2020 found use of telemedicine in the US was minimal. Growth was slow, hampered by irregular insurance coverage policies and hurdles like high startup costs, workflow reconfiguration, clinician buy-in, and patient interest.  

That all changed in 2020. With the onset of the pandemic, usage soared. Massachusetts lawmakers passed a suite of pandemic-focused reforms to enable broad use of telehealth. The new regulations made coverage for telehealth services and cost parity between telehealth and in-person behavioral health services permanent. For primary care and chronic disease management, in person and telehealth cost parity changes were temporary. 

Two-thirds of covered outpatient visits in Massachusetts in April 2020 were telehealth visits, settling at about 31 percent of those visits over the course of the year. “As the most acute phase of the pandemic has ended,” the Massachusetts Health Policy Commission wrote in 2023, “telehealth has remained an important element of the health care delivery system.”  

While the rise of telehealth in the early 2020s “did improve access to care,” an HPC spokesperson said this month, not everyone is able to use the new virtual hospital landscape. “Specific actions could be taken to further enhance access for more rural and vulnerable populations,” the spokesperson said.  

According to new polling data from the MassINC Polling Group for CommonWealth Beacon, many Massachusetts residents aren't leaning heavily into the digital health care transformation. The survey found that 37 percent had no telehealth appointments in the past year, while another 25 percent said less than half of their appointments were conducted virtually. (MassINC Polling Group is partially owned by Commonwealth Beacon’s publisher, MassINC.) 

The poll surveyed 1,000 Massachusetts residents from August 11 to 18 and has a credibility interval of plus or minus 3.5 percentage points. (Topline | Crosstabs)   

Those who make under $75,000 a year were significantly more likely to report no medical appointments in the last year (10 percent) than those making over $75,000 (3 percent). For those who did report medical appointments, higher income brackets were more likely to report fewer telehealth visits, though a majority of respondents of all income levels said they had no telehealth appointments or less than half of their appointments were telehealth over the past year. 

For those who want and can access telehealth, options abound. 

The Bay State has the third highest rate of hospital telehealth adoption in the country – 93.8 percent of its hospitals had installed some sort of telemedicine solution by early 2024.  

Mass General Brigham, the state’s largest health system and private employer, launched a new virtual and artificial intelligence-based primary care platform this month. For now, the program covers MGB patients who are between providers and those in risk-based contracts who haven't come in for a visit in the past year.  

A spokesperson said the health system plans to expand the program this winter to reach new patients who prefer a virtual primary care physician experience. 

“Mass General Brigham always strives to provide the best quality, personalized care for our patients and give options as to how patients access care,” the hospital said in a statement. “Telehealth is a vital tool to expand access to care and lower barriers for patients.” 

Digital tools can ease some of the workforce strain, hospitals and insurers say. Facing weeks, months, or even more than a year of wait time for appointments, patients may opt for telehealth as an initial option if they can access it. 

“We understand how difficult it is for our members to access high-quality, affordable care,” Blue Cross Blue Shield Massachusetts spokesperson Kelsey Pearse said in a statement. “We’re focused on building a network of providers and solutions that can support our members now and navigate them to the care they need when they need it.” 

Blue Cross Blue Shield pointed to 13 percent growth in their primary care network and 48 percent growth in their mental health provider network over the past five years, including in-person and “virtual first” providers. Almost all of the system’s providers offer some sort of telemedicine these days, Pearse noted. The major remote-only vendor through BCBS is the telehealth network Well Connection. Other digital health options that have boomed during the pandemic include the physical therapy app Hinge Health and the virtual women’s health clinic Maven Clinic. 

According to Epic Research tracking, telehealth had declined from its mid-pandemic peak but remained above pre-pandemic levels, especially in behavioral health fields. About 27 percent of mental health contacts were via telehealth in June 2025, compared to less than 7 percent of primary care and 2 percent for urgent care. 

Pandemic aside, remote health care has stayed in the headlines because of its role in accessing abortion medications, something that is increasingly under attack in dozens of states.  

Since the US Supreme Court overturned Roe v. Wade in 2022, the number of people receiving abortion medication prescriptions through telehealth has surged, with a Society of Family Planning report finding that a quarter of all abortions in the United States were delivered via telehealth prescriptions of medication by the end of 2024.  

Massachusetts providers reaffirmed earlier this month that they plan to continue mailing abortion pills to Texas even after its governor, Greg Abbott, signed a first-of-its-kind law that lets anyone sue prescribers and others responsible for getting abortion pills into the state.  

But accessing virtual care requires access to technology and a strong internet connection.  

The Health Policy Commission identified low digital literacy and a lack of access to connected devices and reliable internet as the biggest barriers for patients to access telehealth services. They also found telehealth platforms, patient portals, and other patient communication materials may be challenging to use for those with lower English proficiency or vision and hearing impairments. 

For regions without many accessible care facilities, telehealth is pitched as a partial solution. It may be physically easier to access than distant in-person appointments, but the regions also need improvements to their digital infrastructure to make full use of virtual care. 

“Rural patients face unique challenges in accessing both in-person and audio-video services, creating inequities in care,” according to the National Rural Health Association. “Rural patients, on average, travel further to access health care than their non-rural counterparts. This disincentivizes rural residents from seeking care if they do not have the ability or resources for travel.”    

These areas have less broadband infrastructure and lower rates of smartphone ownership, the advocacy organization notes. Expanded telehealth and rural internet offerings during the pandemic have been a boon, it says, and rural areas “will suffer if such flexibilities are removed.” 

Residents in Southeast Massachusetts were least likely in polling to regularly use telehealth, with just 22 percent reporting that more than half of their appointments were remote and 37 percent reporting no telehealth appointments in the past year. Greater Boston residents were most likely to report more than half of appointments by telehealth (31 percent), with Western and Central Massachusetts regions reporting less regular telehealth usage but also fewer overall medical appointments in the last year. 

Massachusetts lawmakers are still refining the state’s telehealth policies.  

The initial telehealth legislation’s payment parity mandate between telehealth and in-person services expired at the end of 2022, which the Massachusetts Medical Society noted “caused some insurers to reduce reimbursement rates. This variation in payment policies creates confusion and instability for providers and limits patient access to care.” 

Rep. Marjorie Decker and Sen. Adam Gomez have introduced legislation this session to re-establish payment parity for all telehealth services and create initiatives to advance digital health equity.  

A hearing on legislation put forward by Rep. William MacGregor of Boston that would create a special commission to study the accessibility and quality of telehealth is scheduled for September 29. 

This article first appeared on CommonWealth Beacon and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Policy requiring Georgia college professors to put their class syllabus online begins to take effect

by Ross Williams, Georgia Recorder
September 19, 2025

Have you ever wondered what college students are studying these days? Under a University System of Georgia policy rolling out this semester, finding out could soon be easier.

The policy, approved in May, calls for publicly posting all class syllabuses, including a course description, grading policy and reading list, onto university websites.

Starting this fall, syllabuses for mandatory general education and education classes are required to be posted. All courses will need to be viewable ahead of the fall 2026 semester, and all curricula vitae for faculty members involved in classroom instruction, including office address, work email and office phone numbers will need to be made public by the spring 2026 semester.

Some professors are expressing concern that the policy will open them up to harassment from people with ideological bones to pick but without expertise in their subject or connection to the university.

Speaking at a recent Board of Regents meeting, University System of Georgia Chancellor Sonny Perdue sought to tamp down on those concerns.

“I want to remind everyone of our intentions again,” he said. “At a time when many question the value of education, I think this is just one more way that we can show our commitment to transparency and accountability. The goal is straightforward. I just, frankly, was frustrated and confused about those people who objected to being transparent and accountable about what we want to teach.”

Perdue said some University System of Georgia institutions, including the University of Georgia, already have similar rules and the policy gives students clear and accurate information about courses so they can make informed decisions about what classes to take.

“If you’re teaching what you’ve committed in your syllabus, you don’t have a thing in the world to worry about,” he said. “Some are trying to stir up fear about this change. Let me be clear, there’s no cause for alarm to our faculty members who, virtually, by and large, are doing amazing jobs out there educating our students for student success. There shouldn’t be anything to hide.”

Some Georgia professors are expressing concerns after a case out of Texas A&M University in which a professor of a children’s literature course was fired after teaching materials related to gender identity. The university cited a Texas law requiring public colleges and universities to publish syllabuses and claimed the professor’s lessons did not comport with the class syllabus, a claim others dispute.

American Association of University Professors Georgia chapter president Matthew Boedy said Georgia professors fear similar retaliation or groups that could use technology to scrape vast numbers of course descriptions for readings or topics they find offensive.

“The idea that someone, whether it is a university system official or a disgruntled member of the public could say, ‘Well, their syllabus doesn’t match their catalog and they’re not teaching what you should be teaching’ is part of the fear of many professors, because we live in a world where online mobs are directed at people very quickly,” said Boedy, who is also a professor at the University of North Georgia. “I’m all for transparency and many of the professors are for transparency – to parties that have a stake in the classroom – which are, you know, students, and if you want to include parents in that.”

A survey of higher education faculty in Georgia released this month by the state chapter of the American Association of University Professors found 19.6% of respondents reported having curriculum choices questioned by administrators in the past year.

Another 23% of respondents said they are planning to apply for a job in another state in the coming year.

Of those, the most common reason listed for wanting to leave was their salary, reported by 62%. The next top reasons were Georgia’s “broad political climate,” listed by 56.5% and academic freedom, cited by 46%.

In an open response section, some professors described feeling overly scrutinized. Others worried they could be doxxed by “demagogues” or that they were being saddled with a pointless administrative burden.

Georgia Recorder is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Georgia Recorder maintains editorial independence. Contact Editor Jill Nolin for questions: info@georgiarecorder.com.

The cost of child care is hurting working West Virginians. A new program aims to help if lawmakers will fund it.

This story was originally published by Mountain State Spotlight. Get stories like this delivered to your email inbox once a week; sign up for the free newsletter at https://mountainstatespotlight.org/newsletter.”

by Tre Spencer, Mountain State Spotlight
September 21, 2025

Heather Clark has juggled working full-time at an insurance agency and caring for her young daughter for the past five years.

“When you have a kid at home, you can't answer the phones, and you can't have that personal interaction,” said Clark, who often works from home. “And my job requires that.”

In July, Clark became one of the first of 28 parents to join West Virginia’s new pilot program that subsidizes child care by allowing employers and the state to cover some of the costs.

But the program is small compared to the size of West Virginia’s child care crisis, and it won’t survive if lawmakers don’t step up with more money.

Clark is now saving $80 a week on three days of child care for her five-year-old daughter, Gabby. 

“It just helps ease the gap between making bills and getting to save,” she said.

Clark isn't alone. 

Finding affordable child care is one of the biggest hurdles for West Virginia families finding and keeping jobs, business leaders say. 

West Virginia suffers from a lack of providers, low pay for child care workers and insufficient funding subsidies to help low-income families. More than 25,000 West Virginia children don’t have care because providers don’t have enough slots.  

And lawmakers haven’t done much to help families or child care providers, other than implementing new tax credits for employers and families. 

The program is helping parents like Clark afford child care, but it’s only available in eight counties and is expected to end in August 2026 — or sooner, if the number of parents participating exceeds the limited budget. 

That leaves lawmakers with a choice: expand the program or let it fizzle out and go back to the drawing board for West Virginia's child care crisis.  

A new model for child care 

The new approach asks employers to pay a portion of an employee's child care costs. Depending on parents' income, the state matches the employer’s contribution by as little as 50% up to 100%. Parents pay the rest.

Wonderschool, a child care company, is spearheading West Virginia’s program, launched earlier this year in collaboration with the state’s small business development agency. 

The program is funded by a two-year, $1.9 million grant from the Appalachian Regional Commission and $495,000 from the state Department of Economic Development.

So far, the program has enrolled 14 employers and 17 child care providers in eight counties: Putnam, Wirt, Lincoln, Boone, Kanawha, Jackson, Roane and Mason. There are about 40 new employees in the process of enrolling.

Jason Moss, director of government affairs for Wonderschool, said the model can help small and medium-sized employers that can’t afford to provide child care on their own. 

“Just this week, I've had several CEOs call me who are not in the eight counties saying, ‘Hey, what's it going to take to bring this to our county?’” he said. 

One participant, Hospice Care of West Virginia, has five employees enrolled so far. The company puts in $100 per month per employee to cover a portion of child care costs. 

Ashley King, director of human resources and volunteer services for Hospice, said the program could help in the health care industry, where turnover is high.

“We look at it as a retention tool. We’ve had employees in the past, cut hours or step back in the summer because of child care costs,” she said. 

‘We’ve got to start to reform child care in West Virginia’

The model isn't unique to West Virginia.

Michigan officials piloted the program four years ago. After serving over 250 employers and saving the families $8 million a year in child care costs, the program was launched statewide with permanent state funding.  

Lawmakers in West Virginia put several bills on the back burner during this year’s legislative session, after years of working groups and debates at the state capitol.  One bill would’ve created a subsidy program for child care workers, and another would have increased rates paid to providers. 

Child care is a major issue for three-quarters of the state Chamber of Commerce’s members and their ability to attract and retain workers, Brian Dayton, vice president of policy and advocacy, said. 

“We are last in workforce participation in the United States,” he said. “We’ve got to start to reform child care in West Virginia.”

This article first appeared on Mountain State Spotlight and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.