HELENA, Mont. – Starting today, tens of thousands of low-income Montanans will qualify for subsidized health coverage on the federal health insurance marketplace.

The federal Centers for Medicare and Medicaid Services (CMS) have approved Montana's Health and Economic Livelihood Partnership (HELP) plan, which uses money from the Affordable Care Act to expand Medicaid to cover residents with incomes up to 138 percent of the federal poverty level, or almost $33,000 a year for a family of three.

Heather O'Loughlin, co-director for the Montana Budget and Policy Center, says it's a big win for many of the state's working poor, who until now made too much to qualify for Medicaid.

"We're very excited that CMS has approved Montana's plan," she says. "We think this is going to be hugely important for the people of Montana, particularly the 70,000 Montanans that we estimate will be eligible for affordable healthcare coverage now."

Residents can begin enrolling immediately at the Montana Healthcare Program website at healthcare.mt.gov, but will have to be signed up by Dec. 15 for coverage to start Jan. 1.

The HELP Act passed the legislature in April, but needed federal approval because it allows a private insurance company, Blue Cross Blue Shield, to administer the program.

"This is unique in that Montana is the only state that has passed Medicaid expansion to be implemented through a third party administrator," says O'Loughlin. "Individuals will have access to their network of providers."

The federal government will pick up 100 percent of the cost of the expansion until 2017, and will pay 90 percent after that.


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It's National Nurses Week, and educators and healthcare officials say there just aren't enough of them to go around. A combination of retiring baby boomers and nurses who chose to leave the field after the pandemic has left a projected shortfall of more than 5,400 nurses in Nebraska's hospitals, clinics and long-term care facilities.

Linda Hardy, Nebraska Nurses Association president, explained that the system is not training enough new nurses to fill the vacancies.

"I think across the country we have a nursing shortage," she intoned. "But the other thing we have a shortage of are nurse educators - and also, clinical sites for student nurses to be able to practice their clinical skills."

According to a Nebraska Health Care Workforce Collaborative report, 66 of the state's 93 counties have been declared medically underserved, and nine have no nurses. The report points to degraded "emotional health and well-being" as the main reason for staff shortages.

Hardy added healthcare providers and state officials are studying how to increase the investment in educational facilities and clinical sites to train new healthcare workers, and said one goal is to recruit them when they are young.

"There's a collaborative effort to try and get more healthcare workers, not just nurses but radiology techs, pharmacists, etcetera, into the pipeline from high school kids. So, that's a good thing," she insisted.

Carole Johnson, administrator of the Health Resources and Services Administration, said her mission during National Nurses Week is to highlight the vital role nurses play on the front lines, providing care, comfort and support to patients every day, but added the best way to honor them is to support them from training through retirement.

"You have to be investing in the nursing workforce. And so we're providing scholarships, loan repayment, stipends, upskilling - a whole host of training initiatives to really help ensure that we can recruit people into nursing and that when they're there, that they stay," she continued.


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Birth doulas assist new moms with the stress, uncertainty and anxiety of childbirth, while another type of doula offers similar support to those who are dying.

Death doulas, or end-of-life specialists, give spiritual and emotional support to people nearing death in a nonmedical setting. The word 'doula' comes from the Greek word 'doule,' meaning 'female helper.'

Kim Burgess, end-of-life doula and board certified adult geriatric nurse practitioner for Comforting Transitions, an elder care facility in O'Fallon, said fulfilling a dying person's wish to be in their desired setting is important.

"When I was in the home, primarily geriatric population, people wanted to stay in their home; the comfort of their home, their own surrounding, their own food, their own loved ones," Burgess explained. "I loved to being able to support people in that role."

Training to become an end-of-life doula happens in workshops, with required reading and work-study assignments. Since it is not a federally recognized field, insurance companies do not cover the services. The Illinois Department of Public Health said in 2022, Cook County alone saw nearly 46,000 deaths. Almost 20,000 were between ages 65 and 84.

Death, or what is sometimes called "the other side," can produce feelings of fear, or a sense of denial, especially if a terminal condition has been diagnosed. Burgess observed it is a 24-hour job for loved ones helping someone in their final days or weeks. She has encountered families who are unprepared for the caregiving needs.

"A lot of times, their family is saying, 'We're just overwhelmed, and we have hospice involved, but we still feel like we need some more support,'" Burgess recounted. "An end-of-life doula can be there, giving the family reassurance or making some slight suggestions on how to comfort their loved one."

Doulas can also help plan an advance directive, instructions a person can leave behind about their funeral service or cremation, what to do with a pet or help writing a loving message to family and friends.

A Des Moines-based farm co-op is taking high-tech sports-training into the country and has hired an athletic physician to do it.

The field of high-tech sports training is usually reserved for athletes and other high-level performers but the mindset is taking a dramatic turn, as the Landus Co-op in Des Moines has hired a physician.

Dr. Dehra Harris has spent much of her medical career training the Toronto Blue Jays minor-league baseball players and is bringing those skills to the Iowa countryside. Harris said she has always been drawn to helping people who have to perform physically to make a living.

"You don't have days off. You can't take it easy, right?" Harris pointed out. "It's that 'rub some dirt on it' kind of world. And to be able to take the things that we've been learning, in sports and in medicine, and apply it to this group is just an incredible opportunity."

Harris explained she will start by listening to farmers' physical needs, then developing proper nutrition and recovery programs even if it means responding to a farmer who's delivering a calf at three in the morning, and whatever else it takes to help with America's ag production backbone.

Harris noted her regimen will not stop with physical training. In fact, the Centers for Disease Control and Prevention reports suicide rates are nearly twice as high for farmers compared to the general public. The threat was most severe during the pandemic.

Harris will design wellness plans for farmers' mental health, although she noted getting the information might not be easy.

"I love it when I talk to farmers because I'm going to hear all about their family," Harris added. "I'll hear about everything to do with their farm but I'm also not going to hear a lot about what they need. So, we think that the strategies that are actually going to work best here are actually to approach this as a family, and see what the needs are for the whole unit."

Landus is among the first co-ops in the country to take the new approach.


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