With Community Health Centers' funding facing challenges from pharmacy benefit managers, some state lawmakers are getting involved.

The centers are a nonprofit safety net created by Congress in 1965 to provide health care services to medically underserved communities both urban and rural. They are the medical home for 600,000 Missourians.

They are funded by private insurance and Medicaid, federal government grants, and the 340b drug-pricing program. Under 340b, drug manufacturers agree to discount drugs to safety-net providers in exchange for their drugs being covered by Medicare and Medicaid.

Until recently, insurance companies and pharmacy benefit managers reimbursed the retail price, and the health centers were able to pocket the difference with the mandate they use the money to reach more eligible patients and provide more comprehensive services.

Colleen Meiman, a national policy adviser for state associations of Community Health Centers, said in recent years, the benefit managers have changed their approach.

"What has happened in the past five to 10 years or so is that the PBMs have figured out, 'Wait a second, you're a health center. You're eligible for 340b, we know you're paying less for drugs than everybody else, so we're going to reimburse you less for drugs,' " Meiman explained.

Meiman pointed out 22 states have passed laws against 340b workarounds. A bill to make these practices illegal died in committee in the Missouri Legislature last term.

Meiman noted for decades, the financial stability of Community Health Centers has relied in part on 340b savings, and pharmacy benefit managers are exploiting a loophole.

"Just because you just recently figured out that there's this loophole in the law, and you can get your hands on our savings, does not negate the fact that those savings are critical to keeping the primary-care infrastructure safety net in this country running," Meiman contended.

She added over time, the benefit managers' tactics have evolved to avoid providing 340b drug access in the first place.

"You'll see 'Oh you dispense 340b drugs, pharmacy? We're not going to let you into our preferred network,' is a favorite approach," Meiman stressed. "'We're not going to cover 340b drugs anymore', so there's many different ways of instead of just paying them less, just keep the patients from getting the 340b drug in the first place."

Community health centers serve as the medical home for more than 30 million Americans of all ages.

Sudden cardiac arrest claims the lives of about 250 Michigan children and young adults each year. Legislation signed into law over the weekend aims to reduce that number. The new state law will require all public high school coaches to become CPR and AED certified.

Alexander Bowerson, now a freshman at the University of Michigan, is excited about it. During his senior year at Memphis High School, he says he would have died during wrestling practice had it not been for the quick thinking of a cheerleading coach who was also a nurse, and the defibrillator or AED that was available onsite.

"She knew exactly what to do," he said. "She realized it was cardiac right away, got an AED on me, took one shock and within 15 minutes after my first symptoms, was when I remember regaining full consciousness."

House Bills 5527 and 5528 will also require K-through-12 schools to establish a cardiac emergency response team, and do annual reviews of their emergency plan. The cost for CPR and AED certification is between $15 and $100 - and school districts will not be required to pay for the training.

Under the new law, the mandatory AED and CPR certifications must be obtained through the American Red Cross, American Heart Association, or an organization approved by the Michigan Department of Education. Bowerson said all it takes is a simple online search to see that there are a few kids in the Detroit area this year, who experienced cardiac emergencies.

"So now that it's required, I hope school boards take it seriously - and there's going to be a kid alive today, or whenever it happens, that wasn't going to be alive before, because of these bills," he said.

The new cardiac emergency response law goes into effect starting in the 2025-2026 school year.


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A new report reveals that investing in rural areas can improve essential resources for the people living there. Despite a significant rural population of 46 million in the United States, these regions receive only a minimal amount of grant funding. Back in 2012, the Kate B. Reynolds Charitable Trust launched the Healthy Places North Carolina initiative and allocated $1-hundred million to 10 rural counties. The aim was to improve resource accessibility, and after a decade, their impact report reveals significant progress in areas such as healthy food, recreation and health-care resources.

Adam Linker, vice president for programs with the Reynolds trust, said the key to empowering these communities hinges on close collaboration with the residents themselves.

"The people who know the problems the best are the people who are closest to the issues in the community, and so you have to invest in those leaders, in those organizations so that they can lead the change efforts themselves," he said.

Linker emphasized the power of community-driven solutions for real, lasting change. The report echoes this sentiment, highlighting nearly 600 grants distributed to 61 local organizations across eastern and central North Carolina. Their efforts are making a difference, from setting up addiction recovery centers to improving health-care access.

One community reaping the benefits firsthand is West Marion in McDowell County. Linker pointed to the significance of the West Marion Community Forum, the sole Black-led nonprofit in the county. Historically underserved, Linker notes its pivotal role in creating initiatives such as free public transportation, establishing a thriving community garden and expanding access to vital resources.

"Their community, West Marion, that's predominantly African-American, was at one time they talked about the last that gets snow removal, and through their work of getting to know the city leaders, they're now the first to get snow removal. The city has started paying a lot of attention to what the community has to say," Linker said.

Kristen Burwell Naney, director of learning and impact with the Reynolds trust, believes the last decade has shown that it's not only important for funders to build up community organizations but to also change the way they think about success. She says this work requires a long-term strategy.

"So rather than expecting to see quick changes in population health outcomes, we found that you need to focus on things like detection of changes in networks, relationships, power and problem solving within a community, " she explained.

The report highlights key lessons for funders who want to shift conditions that produce inequality to drive change. Naney explained one important take-away to understand is that differences in organizations' abilities are often due to unequal access to financial and capacity building resources. The report suggests that funders have an opportunity to address these imbalances by offering more targeted support to groups that have historically been underfunded or excluded.

Birth doulas assist new moms with the stress, uncertainty and anxiety of childbirth. 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 non-medical setting, and to their families after the transition. The word 'doula' comes from the Greek word doule', meaning 'female helper.'

Joy Kahn Harter, a mental health counselor for Anchored Passages in Bloomington, specializes in grief and loss. She encourages open dialogue about what is often an uneasy subject to discuss.

"It is truly educating, advocating and connecting people to either present or future resources that will serve them, and underscoring the choices that people do, in fact, have - that many people don't realize that they have," she said.

Harter added one request she has received is with planning 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. In 2021, there were about 1,000 per 100,000 residents, with the average mortality at age 76.

Death, or what is sometimes called 'the other side,' can produce feelings of fear, or a sense of denial - especially if a terminal illness has been diagnosed.

Abby Vincent, a death doula with Joy's House in Indianapolis, said some people really 'lean into' the conversation - and others shy away from it.

"And I think it takes somebody who is comfortable with the topic themselves; takes somebody who's a good listener - that is so much a part of it - and is able to hold compassion and space for some of those hard conversations that need to happen. Because there are some beautiful moments that happen during the dying process," she explained.

Training to become a death doula happens in workshops, with required reading and work-study assignments. Since it is not a federally recognized field, insurance companies don't cover these services. Vincent said she relies on word of mouth and invitations from churches and community groups hosting end-of-life meetings as educational opportunities about the death doula industry.