BOISE, Idaho — The public comment period is open on Idaho's application to the federal government to add work reporting requirements to its expanded Medicaid program.

State lawmakers passed a bill this year requiring that recipients age 19-59 work at least 20 hours a week to maintain Medicaid eligibility. But the waiver must first be approved by the Center for Medicare and Medicaid Services.

Liz Woodruff is a coordinator with Close the Gap Idaho, a network of more than 300 health-care and service organizations. She called the work benchmarks "punitive red tape" that would mean fewer Idahoans have health coverage.

"Idaho would be one of the most restrictive programs in the country,” Woodruff said. “It's a 'one-strike-you're-out' policy – so you miss your reporting for one month, you miss turning in your paperwork, and you lose your health coverage."

There are exemptions to the proposal, including parents of children under 18, people receiving disability insurance and caretakers. Supporters of the waiver are convinced it would encourage self-reliance among recipients.

The public comment period ends November 2.

Work requirements were struck down by federal judges in Arkansas, Kentucky and New Hampshire, and Woodruff said she expects Idaho's provision will also go to court if approved. She said the Idaho Department of Health and Welfare reviewed more than 700 pages of comments on the proposal – many from detractors – in just four days.

"We were disappointed that there were technical points made about how the work requirements would be administered, the costs that might be incurred,” she said. “The fact that Idaho is a large rural state, that would make it complicated for people to report. And, while they had a section in their new application that tried to ease our concerns over that, there were no actual changes made to the application itself."

The new application acknowledges that an estimated 16,000 Idahoans would be affected by the requirements. A federal decision on the proposal could take months or years.

Woodruff noted Medicaid expansion is going ahead as planned, with open enrollment starting Nov. 1 for coverage beginning in 2020.


get more stories like this via email

With the increasing use of digital devices and computers in daily life, we're all exposed to more and more blue light. They may be convenient and help us stay connected, but prolonged exposure could pose real health risks.

One of those risks is interfering with the body's circadian rhythm, the "internal clock" which regulates a person's sleep cycle. Throwing it off can cause insomnia, headaches and eye strain.

Dr. Joseph Nezgoda, president of the Florida Society of Ophthalmology, said it does not mean a person should completely block out blue light, because a broad spectrum of light is needed throughout the day. But it is important to manage exposure.

"Individuals are just usually on their devices much longer and later than usual," Nezgoda pointed out. "Potentially during those times, it may be good to limit the exposure. Again, there's been convincing data in animal models, but in humans, the jury's still out."

One tip is scheduling an eye exam, others include taking breaks around every 20 minutes from digital screens, by looking at something else at least 20 feet away for 20 seconds. And of course, limit screen times before bed.

Dr. Scott Edmonds, chief eye care officer for UnitedHealthcare Vision, said eye specialists became concerned during the pandemic about blue-light exposure as more people started using digital devices for longer time periods at home. He worries soon, some of the same concerns will surface about blue light that happened with ultraviolet light.

"The photo receptors can certainly process blue light, but it puts a lot of strain on them," Edmonds noted. "We're concerned that over time, the retina will become damaged, and we'll start to see age-related macular degeneration from this, like we did with UV light."

In addition to taking screen breaks, eye-care professionals recommend making sure your computer screens are clear and clean, as researchers continue to study potential dangers.

The U.S. saw a surge in cardiovascular-related deaths during the first year of the pandemic, and voices from South Dakota's health community hope it spurs more work to prevent these outcomes.

New findings from the American Heart Association showed more than 920,000 heart-related deaths in 2020 - the highest total since 2003. The report stated it shows how COVID-19 can impact cardiovascular health, including connections to risk factors for heart disease and stroke.

Chrissy Meyer, senior regional director of marketing and communications for the American Heart Association, said it is vital for people to get CPR training, knowing most cardiac arrests happen inside the home.

"If you're ever called upon to give CPR, it most likely is going to be for a family member or a friend, or someone you know and love," Meyer pointed out. "That's really kind of where the urgency comes in, so that everyone is trained and knows how to respond in a cardiac emergency."

Meyer added it is also important to consider healthier lifestyle choices, from eating to exercise, to keep those risk factors at bay. Meanwhile, the Heart Association said the Asian, Black and Hispanic communities saw the biggest increases in heart-related deaths, prompting the need to improve access to preventive care from providers and health agencies.

Shannon Bacon, senior health equity and partnerships manager for the Community HealthCare Association of the Dakotas, said many social and structural barriers can affect health outcomes. She explained community health centers are now tailoring their patient screenings to look at what she describes as the "social drivers of health."

"And so, this is a recognition that we can provide excellent clinical care, and yet, we also need to pay attention and ask questions like, 'Does someone have enough food at home? Do they have a place to sleep? Are they at risk of losing housing?' " Bacon outlined.

She noted it can spark conversations about how to access other types of resources. Bacon added South Dakota's recent move to pass Medicaid expansion under the Affordable Care Act will play a role in establishing more equitable health outcomes. The new statistics from the Heart Association coincide with the start of American Heart Month.

February is American Heart Month, and an Arizona expert said it is important to know the signs of a heart attack versus cardiac arrest.

Dr. Wilber Su, director of Cardiac Electrophysiology at Banner Health in Phoenix, said both are medical emergencies requiring immediate lifesaving attention, but they are different conditions.

He explained a heart attack happens when a blocked artery affects blood flow, and blood carries oxygen to the heart. Cardiac arrest involves the sudden malfunctioning of the heart's electrical impulse, which means it stops pumping.

Su urged if you think you're having either one, call 911 as soon possible.

"Call for help and start chest compressions," Su advised. "Because then, somebody has to keep the blood circulating to provide blood flow to the brain, a vital organ, so that we can keep the person alive."

Su noted arteries are often blocked by a buildup of fat or cholesterol. Some of the most common heart-attack signs include tightness, pressure or an aching sensation in the chest which can spread through the upper body, plus shortness of breath, fatigue and dizziness.

Cardiac arrest is a leading cause of death in the U.S., with more than 356,000 cases a year, 90% of which are fatal.

Dr. Ravi Johar, chief medical officer at UnitedHealthcare, said a cardiac arrest can happen to a teenager playing baseball, who's hit by a ball at the exact moment in the heartbeat cycle to disrupt it. He added family medical history and genetics can help determine if someone is prone to experience cardiac arrest or a heart attack. Screening and tests are encouraged for those with high-risk family history.

"Things like Marfan syndrome increases the risk of aneurysms and abnormal blood flow to the heart, and things of that sort," Johar outlined. "There can be some genetic consequences. There can also be genetic history; if your parents had problems with their hearts, there's a higher likelihood that you may."

Experts say routine cardiac care can help ensure a better quality of life, especially as a person ages, including getting EKGs and ultrasounds, which can help prevent many issues further down the road.