A private hospital room in a metropolitan city should not cost more than the average tariff of a three-star hotel room in the vicinity, a parliamentary committee has recommended as part of a series of measures to make healthcare more affordable and curb out-of-pocket expenditure.
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MACY, Neb. — Erica Carter is passionate about her job, and she has seven acres of flowers and vegetables to show for it.
Carter’s specialty is reeling in grants to support students in the Omaha Nation school district, where she is a finance manager. One paid for the garden that sits next to the district’s campus. Another allowed the school system, in one of Nebraska’s lowest-income counties, to pay students to maintain it.
“They’re out in the sun. They’re watering plants,” she said. “It’s the first time they get a paycheck in their life.”
Carter, 41, is paralyzed from the chest down, an injury she’s lived with since a fall in her early 20s. It didn’t slow her down as she built her accounting career and got a master’s degree in human resource management.
But in November 2023, Carter — who lives in Sioux City, Iowa — got a letter from Iowa’s Department of Health and Human Services. It said that her income was too high for her to stay on Medicaid and that she might lose her benefits in two weeks if she didn’t take action.
States are scrambling to get ready for a new federal requirement to double-check that many people on Medicaid qualify for the benefit, by showing they are working, volunteering, or studying at least 80 hours per month. Politicians’ focus on requiring work has angered many people with disabilities who have Medicaid and say current policies that apply to them have the opposite effect — making them choose between working or receiving benefits.
‘I Have No Options’
When Carter got the letter, she was making $110,000 a year, well above Iowa’s 2023 income limit for working people with disabilities: $36,450 for a household of one.
“I had no time at all to prepare,” she said. “I had a decision to make.”
At the time, Carter got her health coverage through Iowa’s Medicaid for Employed People With Disabilities, a buy-in program that allows working disabled Iowans to pay part of their income to the state to maintain access to Medicaid benefits. Forty-seven states offer Medicaid buy-in programs, but most restrict eligibility through limits on income and assets.
For years, disability rights advocates have pushed state legislatures to change the limits, arguing they prevent people like Carter from accepting raises or building savings, for fear of losing crucial medical benefits. Massachusetts, Minnesota, New Jersey, and Rhode Island have eliminated such limits over the past five years.
To keep her Medicaid coverage, Carter would’ve had to find a job paying her far less than she was making. Or she could drop her Medicaid coverage and enroll in the school district’s health plan. But that plan didn’t cover many of the disability-related expenses that Medicaid did.
Carter decided to keep her job and leave the Medicaid buy-in program. In the end, the decision felt like a no-brainer, she said.
“I like getting up and going to work every day, and I really like what I do,” she said. “Why would I throw that away?”
Carter says she has helped write grants for projects such as a student-run garden and a new playground for the Omaha Nation public school district in Nebraska. She chose to give up her Medicaid coverage rather than quit her job as a district finance manager when her income surpassed the cap allowed for beneficiaries in an Iowa program for workers with disabilities. (Natalie Krebs/Iowa Public Radio)
But it’s been hard on her finances. Carter said she now spends about $35,000 a year out-of-pocket for expenses her old plan covered, such as the nurse who visits her three times a week, modifications to her car, and wheelchair repairs.
“I had the motors go out on my wheelchair,” she said. “So that was like $4,000 to fix.”
Over the next year, Carter picked up extra jobs and cashed in some of her retirement savings.
“I want to pay my own way. I don’t mind paying taxes,” she said. She doesn’t want to hide her income, either. “I just want an option,” she said. “I have no options right now.”
A Program Intended To Encourage Work
Congress approved the option for states to create Medicaid buy-in programs in the 1990s, intending to incentivize more people with disabilities to work. Iowa was one of the first states to adopt the program.
According to state data, 11,640 Iowans were participating in the buy-in program as of late January, or 1.7% of all Medicaid recipients in Iowa.
The income caps have inched up since Carter got her letter. Iowa’s limit, set at 250% of the federal poverty level, is $39,900 for a household of one this year.
The rules also restrict recipients from accumulating too much in assets. The current cap is $12,000 for an individual or $24,000 for a married couple, excluding some assets, such as a primary home or vehicle.
Carlyn Crowe, the public policy manager at the Iowa Developmental Disabilities Council, said the limits can prevent disabled Iowans from reaching their goals. “Work full-time and be able to buy a house, live in the community, buy a car,” she said. “Those limits placed on what they can earn and save are keeping them from doing that.”
Crowe’s organization, which has counterparts in every state, is federally funded and advocates for people with disabilities. In Iowa, such advocates have asked legislators to drop the hard limits on income and assets. Instead, they suggest that disabled Iowans pay 6% of their income to buy into the Medicaid program, an approach modeled after a 2024 Tennessee law that created a Medicaid buy-in program with no income and asset limits. (Tennessee is waiting on federal approval before starting its program.)
In recent years, these efforts have built bipartisan support and gained traction. An Iowa House committee unanimously advanced a bill in 2025 to remove the income and asset caps, but the bill died after failing to move forward during this spring’s legislative session.
State legislatures now face federal reductions in Medicaid spending estimated at more than $900 billion over 10 years, as part of the One Big Beautiful Bill Act.
Alice Burns, an associate director of KFF’s Program on Medicaid and the Uninsured, said the specific worry is that buy-in programs, though they’re a small part of the larger Medicaid system, could increase overall Medicaid spending if eligibility changes.
“The premiums charged in buy-in programs are nowhere near close to the expected costs of covering people,” Burns said. (KFF is a health policy research, polling, and news organization that includes KFF Health News.)
Focusing on initial cost increases is myopic, said Daniel Van Sant, the director of disability policy at The Harkin Institute at Iowa’s Drake University. More workers mean additional income tax revenue for states. It also enables some people with disabilities to earn enough to transition off other government assistance programs, such as the Supplemental Nutrition Assistance Program.
“Three, five, seven years from now, you may be recouping those expenses by having people be able to work their way off,” Van Sant said.
Falling Through the Cracks
Iowa lawmakers tried a more modest adjustment during this year’s legislative session. Instead of removing the income limit entirely, they introduced legislation that would raise the cap to 300% of the federal poverty level and exempt pension accounts and a spouse’s income, among other things, from the asset cap.
In the end, the provision was stripped from a wide-ranging public assistance bill. If it had passed, the new income limit would have been one of the highest in the country for a buy-in program, according to KFF.
Alex Watters, a former City Council member in Sioux City who was paralyzed from the chest down after a diving accident, told state lawmakers during a hearing in February that the proposal was a step in the right direction, but not enough.
“I fear that we’re going to lose people to other states,” said Watters, who added that he was considering moving to Minnesota, which never had an income cap and eliminated asset caps for its Medicaid buy-in program in 2024.
Even if Iowa had raised its income limit, Carter would still have been ineligible.
Carter remains committed to her primary job at the school district. She plans to keep working there and taking on additional jobs, seven days a week, so she can pay for her medical needs and continue helping students.
Carter makes her way through the cafeteria at the Omaha Nation Public Schools campus, where she works as a finance manager. (Natalie Krebs/Iowa Public Radio)
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
The recommendation is part of the 176th Report of the Department-related Parliamentary Standing Committee on Health and Family Welfare on 'Affordability and Accessibility of Healthcare Facilities in Public and Private Sector', presented in the Rajya Sabha on August 7.
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This comes after a parliamentary standing committee recommended capping room rents in private hospitals across major metros, benchmarking them to average tariffs charged by nearby three-star hotels.
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The top court's direction came after it was informed that 17 of the 36 states and UTs have so far notified cancer as a "notified disease" in light of the recommendations made in a parliamentary standing committee report.
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Last year, Baltimore had three mass overdose incidents in the span of three months in its Penn North neighborhood.
In one incident, more than two dozen people were hospitalized after many were found unresponsive, lying in the streets or on sidewalks. No one died, but some came close.
Follow-up testing found that the street drugs contained high levels of N-methylclonazepam, a benzodiazepine that operates similarly to Xanax or Valium. Like opioids, benzodiazepines suppress breathing. When they’re combined, the risk of overdose goes up. And benzodiazepines don’t respond to opioid overdose reversal drugs.
Afterward, the Baltimore Harm Reduction Coalition created test strips specifically for benzodiazepines. The group distributed them — along with test strips that identify other harmful adulterants, such as fentanyl, xylazine, and medetomidine — at clinics and neighborhood events. The strips, available at no cost, can also be found in bars and spread out on street corners. People testing drugs mix a small amount with water and then dip a test strip into the liquid. The strip will change color if it identifies an adulterant.
“Nobody really knows what they’re getting whenever they’re getting stuff off of the street,” said Candy Kerr, a spokesperson for the coalition. “Having the test strips available for the general public gives them the option to move slower if they’re going to use whatever they’re going to use.”
A box with free drug test strips, used to detect fentanyl and other harmful adulterants, sits outside the Chesapeake Detention Facility in Baltimore. Many health advocacy groups try to give the strips to people leaving incarceration, to avert overdoses. (Scott Maucione/WYPR)
But a new federal policy could make it harder for organizations such as Kerr’s to give out the test strips, and they’re worried that overdoses could increase. In late April, the Substance Abuse and Mental Health Services Administration banned the use of federal grants for distributing strips to the public and for some other harm reduction practices that have been credited with saving lives. Test strips have been used for nearly 10 years to identify adulterants.
A letter sent to local health departments and nonprofits that provide addiction services explained that the Trump administration believes those harm reduction practices “facilitate illicit drug use and are incompatible with Federal laws.”
According to the letter, grants from the Department of Health and Human Services also cannot be used for programs that support the use of clean needles or drug paraphernalia such as pipes, or to fund a type of specialized hotline that people can call while taking drugs, so someone is aware and can call for help if they overdose.
The Trump administration wants to focus more on other techniques, such as giving out naloxone, an overdose reversal drug available as a nasal spray, according to Emily Hilliard, an HHS spokesperson.
“It is critical that federal funding provided by the American taxpayer goes to effective, common-sense solutions that have been proven to save lives and keep people out of an endless cycle of addiction and moves them into a life of recovery,” she said.
The new policy does not prohibit federal funds from being used to purchase test strips for use by law enforcement officers, public health officials, EMTs, or other medical professionals.
That creates an important exception for government agencies that test drugs and send out regular reports on what adulterants are saturating the drug supply in certain locations.
Still, Yngvild Olsen, who oversaw SAMHSA’s Center for Substance Abuse Treatment in the Biden and Trump administrations, says there is a substantial body of evidence that shows giving test strips to people who use drugs can change behavior.
“There’s some people deciding not to use the substances, some people deciding to reduce, to use less, or take other types of precautions, including naloxone, and making sure that there are people around that can actually then help in the case of an overdose,” Olsen said.
Kerr said the best approach would be to continue to promote the use of test strips while also continuing to give out lifesaving medications like naloxone. She believes that working on all fronts has helped lead to Baltimore’s decline in overdose deaths, which have dropped more than 40% since 2023.
Naloxone, an overdose reversal drug, is spread out on a street corner for people to take after a 2025 mass overdose incident in Baltimore’s Penn North neighborhood. (Scott Maucione/WYPR)
Under the new policy, nonprofits will still be able to hand out test strips, but they will have to find other funding for that work, which Kerr finds worrisome.
“We’ve been making these strides forward because we’ve had these things, because we’ve been funded,” she said. “We’re going to have to pull money from other places.”
To pay for the test strips, Kerr said, the Baltimore Harm Reduction Coalition will have to cut back on services such as giving out hygiene and wound care kits. But she said that option is better than risking another mass overdose in Baltimore — or allowing even just one preventable fatality.
This article is from a partnership that includes WYPR, NPR, and KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Molbio Diagnostics aims to secure ₹200 crore to enhance its capital expenditures through a new issuance of shares. In tandem, the firm intends to reduce promoter stake by generating ₹740 crore via an offer for sale. With six manufacturing sites worldwide, the company caters to over ninety nations and has seen substantial revenue growth attributed to its tuberculosis diagnostic test kits.
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The study highlights the growing financial burden of healthcare on India’s workforce and shows that many corporate employees may not be prepared to withstand a prolonged loss of income. Hospitalisation costs, lifestyle diseases, health cover for family, mental health and a lack of emergency savings emerged as the top five healthcare-related concerns among corporate employees.
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India’s medical device industry and healthcare groups have opposed the draft Drugs, Medical Devices and Cosmetics Bill, 2026, arguing that treating medical devices like pharmaceuticals and imposing criminal penalties for regulatory lapses could hurt manufacturing, investment and innovation.
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Indian Institute of Technology Guwahati researchers have developed an optical sensing device that can instantly detect a variety of toxicants in water and other biological samples.
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