by Audrey Dutton, ProPublica, and Kelcie Moseley-Morris, States Newsroom

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

With a steady but urgent cadence, Dr. Jim Souza told reporters what would become one of the most cited talking points in a protracted legal fight over Idaho’s abortion ban: Without a court order protecting emergency room doctors from prosecution, his hospital system was sending patients to nearby states when certain pregnancy complications meant termination might be necessary.

It was April 2024. Souza said Boise-based St. Luke’s Health System had airlifted six pregnant patients in a span of four months to states where abortion was a legal treatment option in health emergencies. That happened once in all of 2023, a time when a court order kept Idaho from enforcing the ban in those cases.

Souza, the hospital system’s chief physician executive, said Idaho’s law was a looming threat to hospital workers and quality health care. St. Luke’s delivered about 41% of Idaho babies last year.

“Fear is the problem. Fear of prosecution,” Souza said at the time. “And even if it doesn’t occur, it doesn’t fix the jeopardy that is actively eroding our system of care.”

Less than a year later, St. Luke’s is the one major institution — other than advocacy groups — standing in the way of restrictions on emergency abortion care in Idaho, a state with one of the most absolute abortion bans in the country.

The Justice Department on March 5 dropped a lawsuit brought under President Joe Biden that claimed Idaho’s ban, which does not allow abortions to protect a patient’s health, violated a federal law mandating access to emergency medical care. St. Luke’s administrators, who made the same claim in their own lawsuit in January, vowed to press on. A temporary court order in the St. Luke’s case will allow emergency abortions to take place for now.

The abortion lawsuit is the latest controversial stance for a hospital system operating in a state whose political climate treats public institutions — hospitals, libraries, schools, health departments — not as the basic infrastructure of society but as ideological battlegrounds.

St. Luke’s defended its medical staff during the pandemic in 2020 and 2021, when residents objected to masks and vaccines. It took on Ammon Bundy, one of the state’s flagbearers of far-right extremism, whose followers protested against hospital employees caught up in a child welfare case involving the grandchild of one of Bundy’s friends.

St. Luke’s administrators declined to speak with States Newsroom and ProPublica for this story, citing the ongoing litigation.

Idaho Attorney General Raúl Labrador, who is defending against the abortion challenge, has accused health care providers of deliberately misconstruing the ban’s prohibitions. Labrador, whose career was built on being to the right of mainstream Republicans, also has said, without providing evidence, that the reason doctors are leaving Idaho is because they made “the vast majority of their money on abortions, or they wanted to live in a place that allowed abortions.”

The state lost 22% of its OB-GYN workforce and more than half the specialists who handle high-risk pregnancies in the 15 months after the Supreme Court abortion decision, according to a report from the Idaho Coalition for Safe Healthcare.

Odette Bolano, the former CEO of Saint Alphonsus Health System, a St. Luke’s competitor, said health care institutions have historically been reluctant to take on anything with political implications. They often stay neutral because they care for all patients regardless of politics.

But Bolano, who led the Catholic-based system for six years, said everything seems to have taken on political undertones in recent years. She said health systems now have to take difficult positions when they feel something keeps them from delivering safe care.

“The price in reputation — regardless of whatever stance you take and steps you take to safeguard patients, visitors and the community at large — could be significant. It could land you in a very bad place,” she said, “but values, integrity and ability to deliver on commitments have to take precedence.”

St. Luke’s Boise Medical Center (Otto Kitsinger for Idaho Capital Sun)

In a small state like Idaho, where the population just crossed 2 million, St. Luke’s is a behemoth. It has eight hospitals and ranks among the state’s largest employers, with a workforce of 18,000 and more than $4 billion in revenue.

It’s also a nonprofit and unaffiliated with any national chain or any church, despite its name.

During the COVID-19 pandemic, St. Luke’s took in a crush of critically ill patients. Some had ignored public health advice and listened to people who said vaccines were harmful — including a local pathologist who promoted COVID-19 vaccine skepticism and ineffective treatments, then won appointment to a public health board alongside Labrador.

Leading St. Luke’s through the pandemic turmoil was Chris Roth.

Roth joined the system in 2007. He led its Boise-area operations, worked as the system’s chief operating officer, then became CEO when his longtime boss retired in February 2020.

The next month, Idaho went into shelter-in-place mode with the rest of the world. Blaine County, anchored around the Sun Valley ski resort and a tiny St. Luke’s hospital, became one of the nation’s early COVID-19 hot spots.

Roth and other St. Luke’s leaders spoke out in support of public health measures while a small but loud contingent of Idahoans made a show of defying those measures: burning masks at the state Capitol, staging aggressive protests at the Boise region’s health department and showing up at the homes of that agency’s board members.

Souza, who worked as a critical care doctor and pulmonologist in addition to his leadership role at St. Luke’s, gave sobering warnings about the grave reality he saw in the hospital. In the lead-up to the 2020 holiday season, Souza went on a conservative talk radio show and urged listeners to heed public health advice.

When health care organizations including St. Luke’s announced they would require COVID-19 vaccines for employees, anti-vaccine groups set up protests outside hospitals and clinics belonging to St. Luke’s and others.

Roth described a sense of helplessness and anxiety in a 2021 interview with the Idaho Capital Sun: “We’re deeply concerned about our front-line caregivers, and they are just going through hell. Every day. And then they go out to the community, and it’s business as usual — rodeos, fairs, football games, debates in the school boards.”

He spoke of St. Luke’s doctors who faced laughter from the audience at a school board meeting when they described the scene inside hospitals. “It’s like we’re seeing the de-evolution of humanity, right in front of our eyes,” Roth said.

As the nation was starting to emerge from the pandemic in 2022, another source of anxiety arose for St. Luke’s and its hospital workers: Ammon Bundy. The flashpoint was the hospital’s role in a child protection case involving the infant grandson of one of Bundy’s friends.

After police responded to a child welfare report by the baby’s health care provider, the boy was taken to St. Luke’s, where a doctor determined he was malnourished and in need of care, according to the subsequent lawsuit by St. Luke’s and trial testimony. Bundy showed up at the hospital, demanding the baby be returned to his parents. (The baby was returned six days later. No one was charged with child abuse or neglect.)

Bundy was arrested there and later pleaded guilty to trespassing.

Bundy, a self-proclaimed defender against government tyranny, moved to Idaho from Arizona after prevailing against charges associated with the 2016 armed occupation of the Malheur National Wildlife Refuge office in eastern Oregon and a 2014 standoff over his father’s unpermitted use of federal lands for cattle grazing in Nevada.

During the pandemic, Bundy led a crowd that forced its way into the Idaho House of Representatives. He also founded the People’s Rights Network, an organizing apparatus for people with populist, anti-government and survivalist goals.

Bundy, his friend and their followers took to blogs and social media after the friend’s grandson was taken to St. Luke’s, and they coordinated protests outside the hospital, where they were joined by dozens of people, including far-right legislators.

Those protests came to a head one day when Bundy posted a now-deleted video urging people to go to the hospital and begin “making noise” because he believed the baby was about to be transferred to a foster placement and “we need to go back there and get this straightened out. … This is an emergency.”

Demonstrators showed up outside the St. Luke’s hospital in downtown Boise following Ammon Bundy’s calls for protest. (Idaho Capital Sun)

Court records say the hospital went on lockdown and sent ambulances elsewhere for an hour as an angry, armed crowd gathered outside. Callers flooded the switchboard and sent profane and threatening emails to hospital staff and executives. Roth would later read one of the emails from a protester aloud in court. It included antisemitic and homophobic slurs and said Roth was “getting strung up along with everyone else who is complacent in the medical tyranny.”

The hospital system and some of its employees, including Roth, sued Bundy, his friend and their associated commercial operations in May 2022, alleging defamation.

The lawsuit accused them of spinning lies that harmed St. Luke’s and its employees — whose names, photos and personal information spread online via Bundy’s allies and the People’s Rights Network.

Roth, in a court filing, said he worried that parents wouldn’t bring in their children for care if they believed St. Luke’s “secretly vaccinates children and engages in child trafficking.” Citing armed protests against St. Luke’s, Roth said it was important for the health system to stand up to bullying and intimidation.

“Inaction would signal that this type of behavior is acceptable in our community,” Roth wrote. “It is not.”

The baby’s grandfather answered St. Luke’s lawsuit by repeating, without evidence, his allegations against the health system.

Bundy told States Newsroom and ProPublica in a recent interview he personally didn’t make false allegations. He called someone else’s claim that St. Luke’s conspired to kidnap children “so ridiculous.” But in a still-public Instagram post, made while the lawsuit was active, Bundy accused St. Luke’s CEO of being “an accessory to child abduction.”

Bundy decided not to participate in the defamation case against him. For more than a year, he ignored the court proceedings and didn’t show up to the trial to offer a defense.

He thought the worst-case outcome would be a $50,000 default judgment, he told ProPublica.

He was wrong.

A jury rendered a $52 million judgment. Bundy and the People’s Rights Network were responsible for about half. His co-defendant filed an appeal, and the appeal request is pending.

Although Bundy did not appeal, his tangle with St. Luke’s wasn’t over. Bundy had a history of defying legal orders. After state officials barred him from the Capitol, police arrested Bundy multiple times for violating that order. After a court sentenced him to community service, Bundy tried to say campaign events during his failed bid for governor counted as service.

St. Luke’s was not going to let go of its courtroom win.

When Bundy sold his property to a friend so that St. Luke’s would have no claim to it, St. Luke’s sued Bundy again — and it now owns the property.

When he continued to defy court orders, St. Luke’s sought contempt charges. While Bundy was being arraigned, the judge threatened him with arrest if, once again, he failed to show up for a trial. Bundy didn’t show, and the judge issued a $250,000 misdemeanor warrant that remains active in Ada County.

Bundy moved to Utah and, in July, filed for bankruptcy.

Within days of the bankruptcy filing, St. Luke’s was on Bundy’s heels once more. The hospital system has since persuaded the bankruptcy court to order Bundy and his wife to show up and answer questions about their finances and assets.

Bundy has called St. Luke’s actions “lawfare.” When asked for comment on his actions since the defamation suit was decided, Bundy said, among other things, “Sounds like another hit piece.”

The public positions St. Luke’s took during COVID-19 and with Bundy were a precursor to its decision to take a stand on abortion as emergency treatment.

“St. Luke’s is here because we care about the pregnant patients in our community, and we want them to receive the emergency care that is available to anyone who presents to an emergency room,” Peg Dougherty, deputy general counsel for St. Luke’s Health System, said outside Boise’s federal courthouse last week.

Idaho’s trigger abortion ban was ready to go two months after the Supreme Court struck down Roe v. Wade’s protections of abortion rights in 2022. It criminalizes the termination of a pregnancy at any stage. Penalties include prison time, and the physician’s medical license can be revoked. There are exceptions for documented rape and incest or to save a pregnant patient’s life, but not to preserve the patient’s health.

Opponents say a health exception is essential in rare cases where emergency abortion is the best treatment option, such as when a patient’s water breaks before the fetus is viable. That can quickly cause a deadly infection.

In a brief to the Supreme Court describing one such case, an abortion rights group said the doctor, whom it did not name, decided it was necessary to wait until the patient’s condition was life-threatening before feeling legally permitted to end the pregnancy. The group described the experience as “traumatic for the patient and torture for the doctor.”

The Biden Justice Department sued the state in 2022. The agency alleged Idaho’s ban conflicts with a federal law, the Emergency Medical Treatment and Labor Act, requiring any emergency room that accepts Medicare to offer stabilizing treatment to every patient who comes through the door.

A series of shifting appeals and court orders in the case left emergency abortion care in Idaho legal, then illegal, then legal again since June. Anticipating that the Trump administration would drop the Biden-era challenge, St. Luke’s sued in January, seeking a new order while the case proceeds. Senior U.S. District Judge B. Lynn Winmill granted St. Luke’s request for a temporary order on March 5, keeping emergency abortions legal while Winmill considers a longer-term injunction.

Dr. Caitlin Gustafson, president of the Idaho Coalition for Safe Healthcare and a practicing family medicine obstetrician, said it is remarkable that St. Luke’s is willing to use its power so that patients and doctors don’t feel abandoned.

“The need for EMTALA isn’t going away no matter what administration is there, and we’re still stuck,” Gustafson said.

She also suspects the lawsuit could be a bulwark against further attempts by politicians and interest groups to dictate the decisions of health care providers.

Physicians and advocates in other states are watching.

Dr. Christopher Ford, an emergency room physician in Wisconsin, has seen the effects of an abortion ban on emergency care, when abortion was effectively prohibited in Wisconsin for 15 months.

“We had patients presenting with partial surgical or medical abortions who were very apprehensive to seek care,” Ford said. “We had very young patients from age 16, up to age 41 or 42, who were essentially septic and at incredible risk of mortality and morbidity.”

He said it seems atypical for a hospital system to take on a lawsuit of this nature, and he is glad to see it.

“It’s definitely a testimony to how important this is and how other hospitals should follow suit,” he said. “Just reading it from the outside looking in, the hospitals are getting involved as a last-ditch effort as the only way to advocate for their patients sitting in front of them.”

When health systems sue, it is typically over business matters. Individual doctors and patients are the usual plaintiffs in abortion cases, along with advocacy organizations like the Center for Reproductive Rights or Planned Parenthood.

For those reasons, St. Luke’s stands out.

“I think it’s a testament to them meeting the moment,” said Melanie Folwell, executive director for Idahoans United for Women and Families, which is organizing an abortion rights ballot initiative for 2026. “We are at an inflection point, and if they don’t act, who will?”

This post was originally published on ProPublica.

by Peter Elkind

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Lincare, a giant respiratory-device supplier with a long history of fraud settlements and complaints about dismal service, is facing its latest legal challenge: a lawsuit that claims its failures caused the death of a 27-year-old man with Down syndrome.

The case, set to go to trial in state court in St. Louis on March 17, centers on the 2020 death of LeQuon Marquis Vernor, who suffered from severe obstructive sleep apnea and relied on a Lincare-supplied BiPAP machine to help him breathe while sleeping. The lawsuit, filed by his mother, accuses Lincare of negligence after the company took seven days to respond to her report that the device had stopped working.

Lincare, the largest oxygen-device supplier in the U.S., with $2.4 billion in annual revenue, has long faced an array of legal issues, but it’s rare for a claim of wrongful death linked to its service and equipment to go to trial. The litigation over what happened to Vernor offers an unusual window into the company’s interaction with a vulnerable patient. This account is based on extensive court filings, including medical records, deposition excerpts and Lincare’s internal “customer account notes.”

Vernor lived with his mother, who was 64 and on disability, in a tidy public housing apartment complex in Madison, Illinois, across the Mississippi River from St. Louis. He suffered from obstructive sleep apnea, a common problem among adults with Down syndrome that is often exacerbated by obesity. Just under 5 feet tall, Vernor weighed 280 pounds.

Since 2015, Vernor had relied on a BiPAP (or bilevel positive airway pressure) machine, which delivers pressurized air through a mask. The device was prescribed after the Sleep Medicine Center at Washington University in St. Louis found that he repeatedly stopped breathing while he slept. “His airway is extremely crowded,” his doctor wrote in his medical notes at the time. Vernor, who was on Medicare, regularly used the device for 10 to 12 hours while he slept, according to his mother.

He spent his days at New Opportunities, a local nonprofit that provides educational opportunities for people with developmental disabilities. “He was a happy young man,” said Kim Fears, executive director of the program.

On Sept. 11, 2020, Vernor’s BiPAP suddenly started making “a loud buzzing or humming sound,” according to his mother, Sharon Vernor. She called the local Lincare office to report the problem, telling the customer service representative that the breathing machine wasn’t working and that it was “something that he needed” and “could not go without.”

The Lincare representative told her that, because his machine was more than 5 years old, under Medicare rules her son was eligible for a replacement BiPAP but that Lincare would first need to obtain a new order from his doctor. This was required for Lincare to collect rental payments for the new device. The representative later recounted making a call that day to the doctor’s office that went unanswered, then faxing the office a request. (Lincare said it was unable to find a copy of the fax among its voluminous records related to LeQuon Vernor.)

In the meantime, the representative suggested unplugging the malfunctioning BiPAP for 30 minutes. That didn’t fix the problem. The representative then promised, according to the account notes, to have a company respiratory therapist contact Sharon Vernor about the problem “until we get him a new machine.”

But that never happened. No one from Lincare, which had an office about 20 minutes away, came out to fix the broken machine or assess LeQuon Vernor’s condition, according to testimony in the case. (Lincare hadn’t performed any home visits or maintenance on the BiPAP since 2015.) As the company acknowledges, Lincare also never offered to provide Vernor with a “loaner” BiPAP to use while waiting for a new device to arrive. Industry veterans say other companies commonly provide temporary replacements while a patient with a malfunctioning device waits for a repair or a new, permanent one to arrive.

Without his BiPAP, Vernor struggled to sleep (and breathe), snoring loudly throughout the night. The Vernors got no further word from the company until seven days later, on Friday, Sept. 18.

Late that morning, Lincare nurse Ann Marie Eberle called Vernor’s mother, explaining that she would be arriving later that day with his new BiPAP. The doctor’s order had finally arrived. Sharon Vernor prepared a breakfast of sausage and biscuits for her son, who hadn’t yet gotten up. She was surprised when he still didn’t appear; the smell of food usually roused him. About 2 p.m., she went upstairs to wake him up.

She opened the door to find her son motionless in bed, with bloody fluid and foam coming out of his mouth and nose. His body was cold. The broken BiPAP sat on the dresser nearby. Frantic, she called 911. “I think my son’s dead! Oh Lord, please God, NO!” she screamed. “Please hurry!”

An ambulance and police cars were still parked in front of the Vernors’ apartment when Lincare’s Eberle pulled up to deliver the new BiPAP machine. “It just gave you a sunken feeling when you saw that,” Eberle later testified. Sharon Vernor met her at the door in tears. Eberle’s notes state that she “SAT WITH MOTHER UNTIL FAMILY MEMBER ARRIVED. POLICE STILL PRESENT UNTIL CORONER ARRIVED WHEN I LEFT.”

An autopsy completed two days later for the Madison County coroner found LeQuon Vernor’s lungs were a “maroon” color, heavily “congested and edematous” — filled with fluid that made it difficult to breathe. The report attributed Vernor’s death to “complications of obstructive sleep apnea.”

In 2022, Sharon Vernor brought a wrongful death suit against Lincare and Washington University, now set for trial next week. Her case accuses Lincare of putting profits ahead of patient care by failing to make sure that her son got a replacement BiPAP quickly and refusing to provide “loaner equipment” in the meantime, because the company didn’t believe it could bill for it.

“In short, when faced with information that LeQuon’s bipap was not working properly, Lincare did nothing,” a December 2024 filing alleged. The company took no action for a week, even though “Lincare knew this was a life-or-death situation for their customer LeQuon.” Johnny Simon, the Vernors’ St. Louis lawyer, said that “this was an avoidable, horrific tragedy.” (Sharon Vernor declined an interview request.)

The suit also accuses the Washington University medical program of failing to respond “in a timely manner” to requests for a new BiPAP order. The clinic’s prescription for LeQuon Vernor’s new BiPAP was signed on Sept. 15 but not sent back to Lincare for two more days. The Washington University medical school declined comment through a spokesperson, citing the litigation. In a legal filing, the university denied the allegations in the suit.

ProPublica has reported extensively on Lincare, which has a decadeslong history of Medicare-related misconduct, including multiple settlements regarding claims of billing fraud. And that misconduct continued even while the company was under government “probationary” agreements requiring it to provide enhanced compliance oversight. On the Better Business Bureau’s website, 939 customer reviews give the company an average 1.28 rating out of 5, offering lacerating complaints about dirty and broken equipment, delivery delays, nightmarish customer service, improper billings, and harassing sales and collection calls.

In emailed responses to questions from ProPublica, Lincare offered its “sympathies” to the Vernor family but asserted that “the allegations against Lincare are false.” The company said that it is legally barred from providing even a loaner BiPAP until it receives a new prescription and suggested that it had no reason to believe LeQuon Vernor faced a life-threatening situation, because “a BiPAP is not a life-sustaining device.” The company added: “Lincare delivers a high level of care to millions of patients in a heavily regulated field. Our response to this case was consistent with legal requirements and our policies.”

Lincare’s lawyers went a step further in a February court filing, blaming what happened on an alleged failure by Vernor’s doctors to provide the new order promptly. “Lincare did its job,” the company argued. “The moment Lincare knew that Decedent needed a new machine, Lincare reached out to Decedent’s medical provider. However, Lincare did not receive an updated prescription until one week later.” The company, they added, was “at the mercy of Decedent’s medical provider to supply an updated prescription.”

Sharon Vernor’s lawyers dispute Lincare’s claim that it was barred from providing a loaner BiPAP without obtaining a new prescription. (A spokesperson for the Centers for Medicare and Medicaid Services declined to address the issue, citing a “pause on mass communications and public appearances” imposed by the new Trump administration.) LeQuon Vernor’s 2015 prescription, filled by Lincare, also specified that he had a “lifetime” need for a BiPAP.

Two former Lincare managers told ProPublica that they were discouraged from dispatching temporary replacement equipment; at least one manager instructed staff to falsely tell customers “all our loaners are out.” One said that, acting on orders from her supervisor, she tossed CPAP and BiPAP devices marked by local offices as loaners into dumpsters. The respiratory companies they later worked for, both said, routinely provided loaner equipment to patients who relied on a breathing device while they awaited a repair or a doctor’s order required to replace it. As one of them put it, “We would make sure the patient is taken care of in that moment.” (“Lincare’s policy is to provide loaner equipment to its patients in accordance with our patient care standards and regulatory requirements,” the company responded.)

In a deposition, Dr. Gabriela de Bruin, a Washington University neurologist who assessed Vernor’s sleep study in 2015, said allowing him to go a week without a functioning BiPAP posed a serious health risk, given the severity of his disease. Noting that Vernor had “severe sleep apnea,” she said, “Anytime we prescribe treatment for obstructive sleep apnea, our recommendation is that patients should use it nightly and should avoid being without their device if they can.” Asked whether Lincare should have understood that Vernor’s apnea created a risk of death, she said, “It’s very difficult for me to say there was this much risk that he could have died.” She added, “But certainly, I would be very concerned.”

A judge in the case dealt Lincare a setback on March 5, ruling that the evidence presented by Sharon Vernor’s lawyers had met the state’s legal standard for seeking punitive damages. That, he wrote, would allow a “trier of fact” to reasonably conclude that “Lincare intentionally acted with a deliberate and flagrant disregard for the safety of others.”

During deposition questioning, Pamela Karban, the manager of the Lincare outlet that handled LeQuon Vernor’s equipment, testified that “we should have referred the mom, if it was that serious, to take him to the nearest emergency room.” Asked whether the company was negligent for not providing Vernor with loaner equipment, she replied: “Yes. We failed to provide that.” Lincare subsequently submitted an affidavit, signed by Karban, stating that she didn’t understand the legal meaning of the term “negligence.”

Doris Burke contributed research.

This post was originally published on ProPublica.

by Audrey Dutton

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

Idaho lawmakers are moving forward with modest efforts to improve the state’s system for investigating deaths, following reports by ProPublica and others that identified major problems. At the same time, counties are moving to shield from public view records that ProPublica relied on in its coverage.

“Before you today is a bill that is a long time coming, and I say that because over the course of decades, since the 1950s, there have been attempts to reform our coroner system,” state Sen. Melissa Wintrow told lawmakers on Feb. 26, in a nod to ProPublica reporting last year.

The Democrat’s bill would spell out new parameters that clarify a coroner’s role. Where current law says “suspicious” deaths should be investigated, the bill lists circumstances such as a suspected drug overdose or a death on the job. It also makes clear that a law enforcement investigation doesn’t take the place of a coroner’s investigation and that the two should happen in parallel. It requires autopsies to be done by a forensic pathologist, not another kind of doctor.

The legislation crossed its first hurdle last week when it passed in the Republican-controlled Idaho Senate with broad support.

Wintrow said coroners’ investigations must be done right.

“If you’ve seen some of the news reports lately, there are families that are upset because we have not consistently been doing this across our state,” she told lawmakers, “and it is imperative that we do that.”

Last year, a report commissioned by Idaho lawmakers highlighted faults in a system of elected coroners — a system dating to the 19th century — that is marked by limited training, almost no state funding and an absence of statewide standards. The report noted that Idaho ranks last among states for conducting autopsies in suspicious, unexpected and unnatural child deaths.

ProPublica later reported on two grieving parents’ experience with a coroner who did little investigation to identify what caused their baby’s death. ProPublica also used legislative and newspaper archives to pinpoint numerous warnings about Idaho’s coroner system and failed attempts to reform it going back more than 70 years.

What’s different this time is that coroners, a group that has opposed past efforts, drafted the legislation that Wintrow introduced. It’s been in the works since the February 2024 state report, by the Idaho Legislature’s Office of Performance Evaluations, that took aim at the coroner system.

But the proposed legislation does not address some of the key problems identified by the state watchdog agency or ProPublica’s investigation.

ProPublica’s review of hundreds of Idaho coroner reports found little consistency in what coroners did to investigate each death. Some coroners followed national standards; others didn’t. Some ordered autopsies in sudden infant deaths and unexpected child deaths; others didn’t. Other states spell out types of deaths for which an autopsy is required every time.

Idaho requires only 24 hours of training every two years, but ProPublica found that 1 in 4 coroners repeatedly fell short. Other states impose consequences for skipping required training.

Wintrow has tempered expectations about a rapid overhaul, saying her bill is not meant to be comprehensive. She called it a starting point that has the support of the Idaho coroners association.

“Is this the end-all, be-all bill? No, but it is the best start we have had, and will increase consistency in our state,” she said on the Senate floor.

Meanwhile, hearings on Wintrow’s proposal triggered an attempt by counties to wall off coroners’ records from public view in Idaho.

One man testified that his teenage daughter, who had epilepsy, died while taking a bath and that his grief was compounded by knowing investigators possessed photographs taken in her death investigation. In response, Wintrow said she asked the Idaho coroners and sheriffs associations for a way to keep such materials private.

(Although courts have ruled that the dead aren’t entitled to the same personal privacy protections as the living, a U.S. Supreme Court ruling found that the privacy interests of survivors justified withholding autopsy images from the public.)

It turned out that the Idaho Association of Counties had a bill ready to go. But rather than simply protecting photographs of bodies, the proposal would make the entirety of a coroner’s investigation exempt from open records law. All the public could see would be a name, age, gender, hometown and cause of death — not the underlying steps coroners take to reach conclusions.

Diamond and Alexis Cooley’s son Onyxx died in his sleep in February 2024 in eastern Idaho. Records from the coroner’s investigation revealed how little work was done before the coroner concluded Onyxx fell victim to sudden infant death syndrome. (Natalie Behring for ProPublica)

According to the association, the idea came from the coroner of Ada County, home to Boise. Rich Riffle, the Ada County coroner, told ProPublica that a county attorney drafted the proposal based on Riffle’s goal to have Idaho treat coroner records more like law enforcement records.

Police records are available for public inspection in Idaho, with exceptions, such as when police are still actively investigating a crime and releasing their records could imperil the case.

“Although we are separate and independent from law enforcement, that doesn’t mean we want to jeopardize a criminal case, and that’s essentially the bottom line,” he said in an interview Wednesday.

Last year’s state watchdog report also recommended lawmakers consider ensuring disclosure of coroners’ records doesn’t impede a criminal case or violate a family’s privacy. It did not specify creating a broad ban.

Ada County initially denied ProPublica’s request last year for coroner investigative records on the deaths of children, for whom Idaho conducts autopsies at a particularly low rate. Similar record requests went to nine other Idaho counties.

After months of negotiation, Ada County began providing heavily redacted records once ProPublica agreed to pay more than $880 for them.

In Bonneville County, which also resisted disclosure, such records revealed the coroner’s failure to follow national standards. The death of 2-month-old Onyxx Cooley, for example, was determined to be a sudden infant death — one with no explanation — after a terse, one-page report and no autopsy. The since-retired coroner, Rick Taylor, noted that state law didn’t set standards for investigations and said that he relied on an emergency doctor’s opinion.

Most coroners approached by ProPublica released their records after attorneys redacted information they said was protected by state law. Photos weren’t included.

In lending its support to exempting coroner records from disclosure last fall, the association of counties wrote: “While a person may be deceased, their reputation is still subject to harm. Next of kin may also be subject to harm by the release of their loved one’s private medical information, and sensitive information surrounding the circumstances of their death. Given these rights, there is limited public value in the release of detailed information in someone’s death.”

Wintrow saw the draft bill during this year’s legislative session and agreed to sponsor it. But the bill’s future is uncertain.

After fielding questions from ProPublica about the bill last week, Wintrow and a lobbyist for the counties said they want to revisit the legislation before they move forward.

Wintrow said she wants coroners to be treated like law enforcement when it comes to open records laws.

“My intention always as a lawmaker is to make sure there’s good balance with everything, so that privacy is maintained and the interest of the public is maintained as well,” Wintrow told ProPublica last week.

Kelli Brassfield, a lobbyist for the counties association, said, “After some discussion, it looks like the language may need to be amended. We are currently working on this.”

This post was originally published on ProPublica.

by Jeremy Kohler

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

In an unprecedented move to funnel more public tax dollars toward groups that oppose abortion, Republican lawmakers in Missouri are advancing a plan to allow residents to donate to pregnancy resource centers instead of paying any state income taxes.

The proposal would establish a 100% tax credit, up from 70%, and a $50,000 annual cap per taxpayer. The result: Nearly all Missouri households — except those with the highest incomes — could fully satisfy their state tax bill by redirecting their payment from the state to pregnancy centers.

The move comes four months after Missouri voters reversed one of the nation’s strictest abortion bans, and just as clinics have begun performing the procedure again after overcoming Republican obstacles.

Supporters of the bill, which last month cleared a key legislative hurdle in the state House, say it gives taxpayers more control over where their tax dollars go and allows them to support organizations that help pregnant women and provide alternatives to abortion. Alissa Gross, CEO of Resource Health Services, which runs four pregnancy resource centers in the Kansas City area, told the committee in written testimony that tax credits have led to a surge in donations to her organization and that a 100% tax credit could bring in even more.

“Our ability to impact more men and women for life as well as build healthy families has been substantial,” she said.

Critics argue the state’s support for pregnancy resource centers, also known as crisis pregnancy centers, diverts tax revenue away from essential services such as health care and public education and becomes a funding stream for anti-abortion advocacy. They say many centers do little to actually help women; instead, they say they merely discourage women from getting abortions.

“A 70 percent tax credit with no cap was excessive. A 100 percent tax credit is absurd,” Katie Baylie, a lawyer and reproductive rights advocate based in the Kansas City area, wrote in testimony submitted to the committee. “It is an insult to Missourians that our lawmakers are spending time even considering this bill.”

Experts in tax policy and philanthropy said a dollar-for-dollar tax credit — for any purpose — is rare and could be much costlier for the state than intended, especially if pregnancy centers actively promote it.

There is a big psychological difference for donors between a 100% tax credit and a 70% credit, the experts said. At 70%, donors still have to pay some taxes, but at 100%, there is no reason to make a donation less than their tax liability.

“I could imagine a possibility where there’s a big publicity campaign by these centers, or a viral campaign, and massive numbers of conservative Missourians decide to effectively defund state government in favor of these pregnancy resource centers,” said David Gamage, a professor of tax law and policy at the University of Missouri law school.

However, expansion of tax credits clashes with another Republican push to eliminate Missouri’s income tax altogether. Two proposals to replace it with a higher sales tax recently advanced in the state Senate, although it was unclear whether they could pass. If Missouri were to abolish state income taxes, tax credits would become meaningless.

The bill represents one more expansion of a measure Missouri lawmakers have been growing for several years. Until 2021, Missouri taxpayers who donated to pregnancy resource centers were able to claim a 50% tax credit for their donations, meaning for every $1,000 in donations, a taxpayer’s bill dropped by $500. That’s when an expansion approved by the legislature in 2019 took effect and raised the rate to 70%. That shifted more of the cost of those contributions to the state, since tax credits work by directly reducing the amount of money a taxpayer owes to the state. Unlike deductions, which lower taxable income, tax credits are a dollar-for-dollar reduction in tax liability. When these credits are redeemed, they prevent the state from collecting that revenue, effectively reducing the total income available for public services.

The legislature also removed a $3.5 million-per-year cap on the program and removed its expiration date.

At the time, the change drew little attention because it was tucked into the same legislation that created Missouri’s trigger law to ban abortion if Roe v. Wade were overturned — a move that dominated headlines. And there were few warnings about how much it could cost.

The bill’s official cost estimate, prepared by nonpartisan legislative oversight staff, projected only a modest increase in taxpayer expense. Raising the tax credit to 70% was expected to increase annual tax credits from $3.5 million to $4.9 million. That estimate assumed donations would remain steady.

But they didn’t. The program has grown significantly, with $11.8 million in tax credits authorized in the past year alone. Still, it remains a small fraction of Missouri’s overall budget; Gov. Mike Kehoe has proposed a $54 billion spending plan for next year.

Once again, legislative research is downplaying the potential impact on Missouri’s budget. The fiscal note for the bill accounts only for the jump from a 70% to a 100% tax credit, without considering the likely surge in donations that such an incentive would trigger — even though increasing giving is the entire point of the policy.

The note says that it was “unclear” whether the enhanced tax credit would encourage more people to contribute and claim the credit, which would lead to more foregone tax revenue for the state.

The legislative research staffer who authored the impact statement declined to comment, and the bill’s House sponsor, Rep. Christopher Warwick, did not respond to questions from ProPublica.

Warwick, a Republican from Bolivar, in southwest Missouri, told the tax reform committee that his proposal empowers taxpayers to support important work without the state “trying to verify what programs work.” He said, too, that he would oppose requirements for pregnancy resource centers to report how they spend the money, saying he wanted to “limit the bureaucracy.”

Warwick’s bill would also increase the tax credit for donations to maternity homes from 70% to 100% and for diaper banks from 50% to 100%. The state has not yet studied the impact of those changes.

A matching bill has been introduced in the Senate but has not yet advanced.

Rep. Steve Butz, a Democrat from St. Louis, argued the tax credit would effectively shift charitable giving from individuals to the state.

“This will be the fourth bill I’ve heard that will reduce revenue, which I guess is clearly your goal here — to reduce the revenue to the state,” Butz told Warwick during a legislative hearing on the bill. He argued that if donors receive a full tax credit for their contributions, they aren’t really giving their own money — rather, the state is effectively making the donation for them. “So I don’t know that I’d consider that much charitable giving.”

In an interview, Butz said he considers himself pro-life and has donated to pregnancy resource centers, receiving the 70% tax credit. However, he said he does not believe the program should take priority over others that receive less or no tax incentives for giving.

Missouri’s approach to crisis pregnancy centers reflects a growing divide between red and blue states. While Republican-led states such as Florida, Texas and Tennessee have ramped up funding for pregnancy resource centers, states led by Democrats, including Massachusetts and California, have warned residents the centers mislead patients by posing as medical clinics while steering them away from abortion.

Missouri is among the national leaders in per capita spending on pregnancy resource centers even before tax credits are factored in, according to data from states that fund them. Kehoe has proposed increasing direct state funding by almost 50% to more than $12 million in the fiscal year that starts July 1.

In a statement, Gabby Picard, communications director in Kehoe’s office, said the governor “is committed to supporting services that help women choose to carry their unborn child to term, which is why his budget recommends increased funding” for abortion alternatives, including pregnancy resource centers.

Missouri was the first state to use tax credits to fund pregnancy centers, becoming a model for other states looking to support the anti-abortion movement. One public health expert who has tracked the impact of pregnancy centers said Missouri has been a leader and innovator in this effort. “What Missouri is proposing really makes them an outlier at the top of the game,” said Andrea Swartzendruber, an associate professor of epidemiology and biostatistics at the University of Georgia.

Warwick’s initiative follows sweeping changes to Missouri’s abortion laws.

In November, voters approved a constitutional amendment guaranteeing the right to abortion and other reproductive health decisions, effectively nullifying a near-total ban that had been in place since 2022, when the U.S. Supreme Court overturned Roe v. Wade.

The first abortion performed under the new amendment took place in Kansas City on Feb. 15, after a judge struck down restrictive licensing rules that had prevented providers like Planned Parenthood from resuming services in the state.

In response, Republican lawmakers have introduced a wave of bills aimed at limiting the amendment’s impact. Among the measures is another proposed constitutional amendment that would restrict abortion and ban gender-affirming care for minors — an effort to combine something that voters support with something they don’t in the hopes it’ll turn off abortion-rights supporters.

Some abortion-rights advocates in the legislature see the expanded tax credit as part of a broader push by anti-abortion lawmakers stung by the repeal of the abortion ban. After the amendment passed, those legislators “needed some wins,” said Rep. Kemp Strickler, a Democrat from the Kansas City suburbs.

“But even if the amendment had lost,” Strickler said, “they probably would have been coming forward with these kinds of things.”

This post was originally published on ProPublica.

by Mara Silvers, Montana Free Press, and J. David McSwane, ProPublica

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In late 2020, St. Peter’s Hospital in Helena, Montana, fired its oncologist, Dr. Thomas C. Weiner, and took the extraordinary step of publicly accusing him of hurting patients. The hospital said the doctor overprescribed narcotics and gave chemotherapy to patients who didn’t have cancer, among other allegations.

Despite being notified by St. Peter’s that it had revoked Weiner’s privileges, the Montana Board of Medical Examiners renewed his license in 2021 and 2023. This week, the board renewed his license again for another two years.

Questions about whether Weiner would be permitted to continue practicing medicine intensified after a December ProPublica investigation exposed a trail of patient harm and at least 10 suspicious deaths tied to his practice. That investigation, which relied on thousands of pages of court records and dozens of interviews, detailed how Weiner built a high-volume business that billed as much as possible to public and private insurance while many of his patients received unnecessary, dangerous or substandard care.

While it’s unclear what the medical board considered before renewing Weiner’s license, the investigation published by ProPublica and Montana Free Press caught the attention of law enforcement. Criminal investigators with the Montana Department of Justice launched an official inquiry this month, according to three sources directly involved in the matter.

Weiner has denied mistreating his patients. He did not respond to a request for comment about his license being renewed and the Montana Department of Justice investigation.

After St. Peter’s fired Weiner, he sued the hospital for wrongful termination and defamation. After a four-year legal battle, the Montana Supreme Court sided with the hospital in a ruling this month. The court wrote that the hospital’s peer-review process leading to Weiner’s dismissal was “reasonable and warranted due to the quantity and severity of Weiner’s inappropriate patient care.”

After it fired Weiner, the hospital inspected the files of more than 2,000 patients to whom he had prescribed controlled substances. Court records show that medical reviewers hired by St. Peter’s highlighted the case of Sharon Dibble, a 75-year-old patient who died shortly after Weiner doubled her morphine prescription. That increase in morphine “led to respiratory arrest and the patient’s demise,” a medical expert hired by St. Peter’s concluded.

Dibble’s son, Tom Stevison, called the medical board’s decision to renew Weiner’s license “ridiculous.”

“There’s just too much evidence against him, pointing to wrongdoing, to recklessly relicense this guy,” he said, referring to the hospital’s allegations and ProPublica’s reporting. “I do believe he should be held accountable.”

Weiner previously denied the allegation that he overprescribed patients, including Dibble, and was critical of the medical review.

In the months after Weiner was fired, thousands of friends and former patients formed Facebook groups in support of him. They raised funds to rent a billboard in Helena that read, “WE STAND WITH DR. WEINER.” On Tuesday, Dayna Schwartz, who led that effort, posted on Facebook, “Congrats Doc on your license renewal!!”

A spokesperson for the state Board of Medical Examiners referred a request for comment about Weiner’s license renewal to its umbrella agency, the Montana Department of Labor and Industry. An agency spokesperson did not respond to questions before publication.

St. Peter’s did not respond to requests for comment on the renewal of Weiner’s license.

The medical board does not typically release information about current or past investigations unless it substantiates allegations of professional misconduct. If it does, a doctor’s license can be suspended or revoked for many reasons, including billing fraud, unprofessional prescribing practices and failure to appropriately document patient care.

The criminal inquiry, led by the Montana Attorney General’s Office, comes just months after the federal government settled with St. Peter’s for making false claims when it billed government health programs for Weiner’s services. The hospital agreed to pay back $10.8 million. The hospital has previously said it provides quality care and “this situation is isolated to a single, former physician, and we remain confident in the exceptional care provided by St. Peter’s medical staff.”

Federal prosecutors also sued Weiner, accusing him of an array of fraudulent practices, including billing federal insurance programs for unnecessary treatments or more expensive treatments than were delivered. Weiner has denied the allegations and, through attorneys, has moved to dismiss the case.

This post was originally published on ProPublica.

by Margaret Coker, The Current

This article was produced for ProPublica’s Local Reporting Network in partnership with The Current. Sign up for Dispatches to get stories like this one as soon as they are published.

In January, standing before a cluster of television cameras on the steps of the state Capitol, Georgia Gov. Brian Kemp promoted his experiment in Medicaid reform as a showcase for fellow conservatives seeking to overhaul safety net benefits around the country.

“What we are doing is working,” Kemp boasted about Georgia Pathways to Coverage. The federally subsidized health insurance program is supposed to cover nearly a quarter-million low-income Georgians who can prove they are working, studying or volunteering.

What the governor did not disclose, however, was that his program is not achieving two primary goals: enrolling people in health care and getting them to work, according to an examination by The Current and ProPublica. The findings were confirmed recently by an independent evaluation commissioned by the state that has yet to be publicly released.

As of the end of 2024, the Pathways program has cost federal and state taxpayers more than $86.9 million, three-quarters of which has gone to consultants, The Current and ProPublica found. The state asserted that costs increased because of a two-year delay to the program’s launch.

A mere 6,500 participants have enrolled 18 months into the program, approximately 75% fewer than the state had estimated for Pathways’ first year. Thousands of others never finished applying, according to the state’s data, as reports of technical glitches mounted. The state also never hired enough people to help residents sign up or to verify that participants are actually working, as Georgia required, federal officials and state workers said.

As a result, the Kemp administration has quietly rolled back a core tenet it heralded when it launched Pathways as an alternative to government entitlement programs for poor people that many conservatives deride as handouts and the nanny state. Rather than verifying that people are working every month, Georgia is confirming that participants meet these requirements only at the time of enrollment and upon their annual renewal, the state said in January.

Georgia’s experience offers a warning for the nation as conservatives attempt to curtail federally subsidized health care for low-income Americans, as outlined by Project 2025, the playbook designed for a second Donald Trump presidency. Congressional Republicans are pushing for deep cuts to Medicaid along with requiring recipients to work. Right now, Georgia is the only state that imposes a work requirement for Medicaid coverage. But nearly a dozen largely Republican-led states are considering work requirements for Medicaid enrollees.

Federal and state officials who have worked on Pathways say a litany of bad decisions, some technical and some political, doomed the program from meeting Kemp’s original goals. Even some lawmakers in Kemp’s own party want to pull the plug on Pathways.

The quarter-million people eligible for Pathways would have had an easier road to coverage had the state simply chosen to expand Medicaid under the Affordable Care Act, the 2010 health reform law that extended insurance to tens of millions of Americans, said Joan Alker, executive director of the Center for Children and Families at Georgetown University McCourt School of Public Policy. Kemp is one of 10 Republican governors who refused federal government subsidies to expand Medicaid under the belief that entitlement programs encourage freeloaders and are a drag on federal and state budgets. Sixteen percent of working-age residents in Georgia lack health insurance, one of the highest uninsured rates in the nation.

In response to Pathways’ low enrollment numbers, Kemp’s spokesperson Garrison Douglas said the governor never thought it was realistic to enroll the entire pool of eligible Georgians in the program. Douglas said Kemp’s health care strategy for low-income Georgians is superior to Medicaid expansion because it saves the state money and funnels participants into private health insurance, rather than what the Kemp administration has described as overregulated government-mandated plans that reimburse hospitals and doctors at lower rates.

“As the governor has said repeatedly, those who continue to promote full Medicaid expansion are selling Georgians a bill of goods,” he said.

The Pathways program is slated to sunset this fall, but Georgia has filed a request with the Trump administration to extend the experiment for another five years with the less stringent verification rules, as independent evaluators recommended. The Trump administration did not respond to requests for comment about its support for Medicaid work requirements and its views on Georgia’s Pathways experiment.

State officials did not explain why Georgia has not been able to meet its own verification standards.

“The governor’s mandate for all state agencies is to continually seek ways to make government more efficient and accessible for hardworking Georgians,” Fiona Roberts, a Department of Community Health spokesperson, said in a written statement.

The state requires Pathways participants to work at least 80 hours a month or be enrolled in school, job training or volunteering — activities the governor’s office says it believes contribute to eventual “financial independence.” Health policy research shows that requiring low-income people to work for health insurance does not increase coverage or boost their economic circumstances because most of them already have jobs.

“If the goal truly is to increase health insurance for low-income Georgians, they are doing it wrong,” said Dr. Harry J. Heiman, a member of a state commission to study comprehensive health coverage and a professor at Georgia State University School of Public Health. “The one thing that Pathways seems to do well is waste taxpayer money on consultants and administrative costs.”

Plagued by Tech Glitches

Pathways was supposed to help a group of Georgians whom the state had previously deemed ineligible for Medicaid: adults between 18 and 64 years old earning less than $15,650 a year if they are single, or $32,150 for a family of four.

The state told the federal government in its application to experiment with Pathways that it hoped to enroll 25,000 of the 246,000 Georgians eligible for Pathways during the program’s first year.

But those seeking coverage faced technical hurdles right away, according to interviews with six applicants as well as federal officials and current and former state employees.

The enrollment portal crashed each of the three times Kelsey Williams tried to apply. The single mother had been kicked off Medicaid last spring, after her son turned 1, per state law allowing her to keep her coverage for a year after giving birth. She called the Pathways customer service hotline for help and was sent through a phone tree that ended in a voicemail asking callers to leave a message.

“You’d go from one robot voice to another,” said Williams, who worked irregular hours as a convenience store clerk outside Macon.

No one called back. She gave up after nearly a month of trying. “I got the feeling that they really didn’t want to help me,” she said.

State officials have paid Deloitte Consulting more than $50 million so far for a software application that often froze and wiped out personal information, forcing applicants to start over. The technology also proved hard to navigate for many of Pathways’ target clients who don’t own smartphones or have access to reliable high-speed internet.

I got the feeling that they really didn’t want to help me.

—Kelsey Williams

As of January, the state’s own documents show that the program had a backlog of 16,000 applications awaiting processing, and in some months, upwards of 40% of people who started applications for Pathways gave up.

An independent evaluation from December, obtained by The Current and ProPublica, analyzed data gleaned from the first 13 months of the Pathways program and noted that applicants experienced administrative barriers to enrollment. People 50 and older had an especially difficult time proving they met the requirements, the evaluation said. The program requires applicants to provide paperwork that verifies their work status, including pay stubs and tax documents. That protocol contradicts Medicaid regulations that states should use available data to confirm most eligibility criteria, when possible, instead of making people provide documentation.

For Georgians who did manage to enroll, the technology problems persisted when they were required to verify each month that they had a job or were otherwise participating in a “qualifying activity.”

Paul Mikell lives in an area outside Atlanta without reliable internet service — and he doesn’t have the income for a phone plan with unlimited data. It takes him more than an hour each month to upload the employment documents necessary to reconfirm his eligibility, often using the free Wi-Fi at his public library.

Sometimes, Mikell said, the task has stretched days, even a whole week, because the Pathways verification portal freezes or crashes. One time, he said, he waited eight days for customer support to retrieve a password and restore his access.

The 49-year-old works part time for a hauling and trucking company in exchange for housing. He also picks up odd jobs to support his young son and elderly father. He does not receive traditional pay stubs that could be easily pulled by the state to verify his work status.

“It’s really, really difficult,” said Mikell, adding that stress over the possibility of losing coverage keeps him awake at night. “But it’s the only health care for someone like me.”

Mikell’s informal employment situation is typical for many low-income Americans who exist outside mainstream financial networks, and illustrates why verification can be an arduous process for programs with work requirements, said Jennifer Wagner, an expert in Medicaid enrollment technology at the Center on Budget and Policy Priorities, a Washington think tank. In Georgia, 65% of people eligible for Pathways are employed at least part time, while many of the rest are tethered to unpaid work such as caregiving that Pathways does not recognize, state data shows.

To help automate the application and verification processes, Georgia uses digital tools to collect wage and work histories of employees at large companies as well as those who are self-employed. But these tools are not comprehensive, and the task of verifying applicants’ eligibility for Pathways largely falls on a cadre of overburdened caseworkers.

In August 2023, a month after Pathways launched, the state was only able to verify that 39 of the 152 enrollees were indeed working or otherwise engaged in activities deemed acceptable by the state, according to state reports to the Centers for Medicare and Medicaid Services. Those reports attributed the low numbers to a lack of “functionality” and did not provide further explanation.

The state’s contracts with Deloitte, which The Current and ProPublica obtained through a public records request, were heavily redacted and reveal no detail about the technical design of Pathways’ digital platform or how it would be tested before launch.

Deloitte declined to comment and referred questions about the technical difficulties to Georgia officials. Roberts, the spokesperson for Georgia’s Medicaid agency, referred to Pathways as “both a policy and technical success” but said it had to work through issues “consistent with the launch of a new program of similar scale and complexity.”

“Based on feedback from customers and the community, the state continues to evolve the Pathways program and its processes,” Roberts said in a written statement.

The state still requires Pathways recipients to upload paperwork every month, but Georgia is only verifying it annually, Roberts said. The state also says it is not kicking anyone off the rolls.

An Overwhelmed Workforce

Loosening Pathways’ verification process does not change what federal and state officials say is another fundamental flaw in the program: Getting people enrolled would ultimately hinge on an understaffed department already struggling to keep up with processing applications for other safety net benefits.

About 30% of the staff at Georgia’s Division of Family and Children Services that oversees benefits enrollment and employment verification had turned over between 2017 and 2022, according to state data. Former agency managers attribute the unusually high churn to a workforce fed up with low pay and high stress, exacerbated by the coronavirus pandemic.

In 2023, the year Pathways launched, the agency was already swamped.

Caseworkers had started the time-intensive task of reenrolling the 2 million Georgians who had traditional Medicaid benefits, a process that happens every five years to ensure that participants still meet the requirements.

Federal officials were simultaneously scrutinizing the department for its backlog of 157,000 food stamp applications and ordered it to develop a “corrective plan” to process those benefits more quickly. Georgia was also slipping behind the 45-day standard for processing Medicaid applications, according to federal data.

Meanwhile, for approximately six months before Pathways started, caseworkers needed extensive training for the new program, further delaying reviews of food stamps and Medicaid applications, former managers said.

That spring, Kemp approved a temporary fix to the department’s workforce shortage: using federal grants to hire 300 additional caseworkers to handle the flood of Medicaid renewals. But state officials did not beef up staffing to handle Pathways applications, according to two federal employees and one former state manager, despite the fact that so much of Kemp’s political capital was riding on the program’s success.

The workload ballooned after Pathways’ launch in July 2023, according to three former caseworkers. “I’d go into work every day with piles and piles of files, and each of those files represented a real human being with real suffering,” said Deanna Matthews, who quit last year. “What people don’t realize is that some of us were processing food stamp applications and our families were struggling and needing food assistance as well.” (Starting salary for a caseworker who determines applicants’ eligibility for federal benefits is approximately $32,000 — the same as the federal poverty line for a family of four.)

I’d go into work every day with piles and piles of files, and each of those files represented a real human being with real suffering.

—Deanna Matthews

In December 2023, the state agency overseeing DFCS moved 200 caseworkers who had been processing applications for Medicaid to tackle the backlog of food stamp applications.

In Pathways’ first six months, the department had enrolled just 2,300 people, according to state data.

In response to questions from The Current and ProPublica, Ellen Brown, a spokesperson for the Georgia Department of Human Services, said the state has committed enough people to administer Pathways but that it “can always use more caseworkers” and continues to hire.

At the state Capitol, Republican legislators representing rural counties, where large numbers of uninsured adults live, had begun questioning their governor’s push for Pathways. They sought advice from other Republican-led states that were expanding Medicaid without work requirements.

Arkansas had removed its work requirements after a federal judge ruled that such policies resulted in a significant number of people losing health coverage, which goes against Medicaid’s rules. The former head of North Carolina’s Medicaid agency testified to Georgia lawmakers that Medicaid expansion would boost local economies, rather than drag down state budgets, as many conservatives fear.

Last spring, a bipartisan group of Georgia lawmakers introduced bills in both the House and Senate to allow Medicaid expansion and let Pathways sink into oblivion.

“What we’re doing so far just hasn’t seemed to work. And so, at some point, we’ve got to be open to more ideas,” Georgia state Sen. Matt Brass, a Republican from Newnan and co-sponsor of the bill, said during a committee hearing at the time.

But the measure never made it to a full vote in either chamber.

Kemp quashed the rebellion after his allies in the Legislature argued that Pathways needed more time to prove itself. Georgia awarded Deloitte a $10.7 million advertising contract last summer to create television, radio and social media spots encouraging enrollment and to tout the program at community events around the state.

As a new legislative session is underway, no bill to abandon Pathways in favor of expanding Medicaid has emerged.

“We are focused on Pathways,” said state Rep. Lee Hawkins, a Republican dentist who represents the rural constituency of Gainesville. “We are going to build on what we’ve got and focus on making it better.”

This post was originally published on ProPublica.