When Lawrence and Penny Higgins of Fairfield, Maine, first learned in 2020 that high levels of toxic chemicals called PFAS taint their home’s well water, they wondered how their health might suffer. They had consumed the water for decades, given it to their pets and farm animals, and used it to irrigate their vegetable garden and fruit trees.

“We wanted to find out just what it’s going to do to us,” Penny Higgins said. They contacted a couple of doctors, but “we were met with a brick wall. Nobody knew anything.”

Worse still, she added, they “really didn’t want to hear about it.”

Many clinicians remain unaware of the health risks linked to PFAS, short for perfluoroalkyl and polyfluoroalkyl substances, despite rising medical and public awareness of the chemicals and their toxicity. PFAS can affect nearly every organ system and linger in bodies for decades, raising risks of cancer, immune deficiencies, and pregnancy complications.

These “forever chemicals” have been widely used since the 1950s in products including cosmetics, cookware, clothing, carpeting, food packaging, and firefighting foam. Researchers say they permeate water systems and soils nationwide, with a federal study estimating that at least 45% of U.S. tap water is contaminated. PFAS can be detected in the blood of nearly all Americans, according to the Centers for Disease Control and Prevention.

Maine was among the first states to begin extensive water and soil testing and to try to limit further public exposure to PFAS through policy action, after discovering that farms and residences — like the Higgins’ property — had been contaminated by land-spreading of wastewater sludge containing PFAS. Exposure can also be high for people living near military bases, fire training areas, landfills, or manufacturing facilities.

In regions where testing reveals PFAS hot spots, medical providers can be caught flat-footed and patients left adrift.

Rachel Criswell, a family practice doctor and environmental health researcher, is working to change that. She was completing her residency in Central Maine around the time that the Higginses and others there began discovering the extent of the contamination. Her medical training at Columbia University included more than a year in Norway researching the effects of PFAS and other chemicals on maternal and infant health.

When patients began asking about PFAS, Criswell and the state toxicologist offered primary care providers lunchtime presentations on how to respond. Since then, she has fielded frequent PFAS questions from doctors and patients throughout the state.

Even knowledgeable providers can find it challenging to stay current given rapidly evolving scientific information and few established protocols. “The work I do is exhausting and time-consuming and sometimes frustrating,” Criswell said, “but it’s exactly what I should be doing.”

Phil Brown, a Northeastern University sociology professor and a co-director of the PFAS Project Lab, said the medical community “doesn’t know a lot about occupational and environmental health,” adding that “it’s a very minimal part of the medical school curriculum” and continuing education.

Courtney Carignan, an environmental epidemiologist at Michigan State University, said learning of PFAS exposure, whether from their drinking water or occupational sources, “is a sensitive and upsetting situation for people” and “it’s helpful if their doctors can take it seriously.”

Clinical guidance concerning PFAS improved after the National Academies of Sciences, Engineering, and Medicine released a report on PFAS in 2022. It found strong evidence associating PFAS with kidney cancer, high cholesterol, reduced birth weights, and lower antibody responses to vaccines, and some evidence linking PFAS to breast and testicular cancer, ulcerative colitis, thyroid and liver dysfunction, and pregnancy-induced hypertension.

That guidance “revolutionized my practice,” Criswell said. “Instead of being this hand-wavey thing where we don’t know how to apply the research, it brought a degree of concreteness to PFAS exposure that was kind of missing before.”

The national academies affirmed what Criswell had already been recommending: Doctors should order blood tests for patients with known PFAS exposures.

Testing for PFAS in blood — and for related medical conditions if needed — can help ease patients’ anxiety.

“There isn’t a day that goes by,” Lawrence Higgins said, “that we don’t think and wonder when our bodies are going to shut down on us.”

‘Devastating but Incredibly Helpful’

After finding out in 2021 that his family was exposed to PFAS through sludge spread on their Unity, Maine, farm decades earlier, Adam Nordell discovered that “it was exceedingly difficult” to get tested. “Our family doctor had not heard of PFAS and didn’t know what the test was,” he said. A lab technician needed coaching from an outside expert to source the test. The lab analyzing the samples had a backlog that left the family waiting three months.

“The results were devastating but incredibly helpful,” Nordell said. Their blood serum levels for PFAS were at roughly the 99th percentile nationally, far higher than their well-water levels would have predicted — indicating that additional exposure was probably coming from other sources such as soil contact, dust, and food.

Blood levels of PFAS between 2 and 20 nanograms per milliliter may be problematic, the national academies reported. In highly contaminated settings, blood levels can run upward of 150 times the 20-ng/mL risk threshold.

Nordell and his family had been planning to remain on the farm and grow crops less affected by PFAS, but the test results persuaded them to leave. “Knowledge is power,” Nordell said, and having the blood data “gave us agency.”

The national academies’ guidance paved the way for more clinicians to order PFAS blood tests. The cost, typically $400 to $600, can be prohibitive if not picked up by insurance, and not all insurers cover the testing. Deductibles and copays can also limit patients’ capacity to get tested. Less costly finger-prick tests, administered at home, appear to capture some of the more commonly found PFAS as accurately as blood serum tests, Carignan and colleagues found.

Maine legislators recently passed, with overwhelming support, a bill — modeled after one in New Hampshire — that would require insurers to consider PFAS blood testing part of preventive care, but it was carried over to the next legislative session.

“In my mind, it’s a no-brainer that the PFAS blood serum test should be universally offered — at no cost to the patient,” said Nordell, who now works as a campaign manager for the nonprofit Defend Our Health. Early screening for the diseases associated with PFAS, he said, is “a humane policy that’s in the best interests of everyone involved” — patients, providers, and insurance companies.

Criswell tells colleagues in family practice that they can view elevated PFAS blood levels as a risk factor, akin to smoking. “What’s challenging as a primary care doctor is the nitty-gritty” of the testing and screening logistics, she said.

In trainings, she shares a handout summarizing the national academies’ guidance — including associated heath conditions, blood testing, clinical follow-up, and exposure reduction — to which she has added details about lab test order codes, insurance costs and coverage, and water filtration.

Criswell served on an advisory committee tasked with allocating $60 million in state funds to address PFAS contamination from past sludge-spreading in Maine. The group recommended that labs analyzing PFAS blood tests should report the results to state public health authorities.

That change, slated to take effect this summer, will allow Maine health officials to follow up with people who have high PFAS blood levels to better determine potential sources and to share information on health risks and medical screening. As with many earlier PFAS policies, Maine is among the first states to adopt this measure.

Screening for PFAS is falling short in many places nationwide, said Kyle Horton, an internist in Wilmington, North Carolina, and founder of the nonprofit On Your Side Health. She estimates that only about 1 in 100 people facing high PFAS exposure are getting adequate medical guidance.

Even in her highly contaminated community, “I’m not aware of anyone who is routinely screening or discussing PFAS mitigation with their patients,” Horton said. Knowledge of local PFAS threats, she added, “hasn’t translated over to folks managing patients differently or trying to get through to that next phase of medical monitoring.”

Patients as Advocates

In heavily affected communities — including in Michigan, Maine, and Massachusetts — patients are pushing the medical field to better understand PFAS.

More doctors are speaking out as well. Testifying before a Maine legislative committee this year in support of a bill that would limit occupational PFAS exposure, Criswell said, “We, as physicians, who are sworn to protect the health of our patients, must pay attention to the underlying causes of the illnesses we treat and stand up for policy solutions that reduce these causes.”

Even where policy changes are instituted, the physical and psychological toll of “forever chemicals” will extend far into the future. Criswell and other Maine doctors have observed chronic stress among patients.

Nordell, the former farmer, described his family’s contamination as “deeply, deeply jarring,” an ordeal that has at times left him “unmoored from a sense of security.”

To assess the mental health consequences of PFAS exposure in rural residents, Criswell and Abby Fleisch, a pediatric endocrinologist at the MaineHealth Institute for Research, teamed up on a study. In its first phase, winding up this summer, they collected blood samples and detailed lifestyle information from 147 people.

Nordell, the Higginses, and other Central Maine residents sit on an advisory board for the study, a step Criswell said was critical to ensuring that their research helps those most affected by PFAS.

“The urgency from the community is really needed,” she said. “I don’t think I would be as fired up if my patients weren’t such good advocates.”

Criswell has faced what she calls “cognitive dissonance,” caught between the deliberate pace of peer-reviewed medical research and the immediate needs of patients eager to lower their PFAS body burden. Initially she considered inviting residents to participate in a clinical trial to test therapies that are considered safe and may help reduce PFAS levels in the body, such as high-fiber diets and a drug designed to reduce cholesterol called cholestyramine. But the clinical trial process could take years.

Criswell and Fleisch are instead planning to produce a case series on PFAS blood-level changes in patients taking cholestyramine. “We can validate the research results and share those,” Criswell said, potentially helping other patients.

Alan Ducatman, an internist and occupational physician who helped design the largest PFAS cohort study to date, said providers should convey that “there is no risk-benefit analysis” for any of the current treatments, although they’re generally well known and low-risk.

“Some people want to be treated, and they should be allowed to be treated,” he said, because knowing they have high PFAS levels in their bodies “preys on them.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

A federal judge on Monday ruled Planned Parenthood clinics nationwide must continue to be reimbursed for Medicaid funding as the nation’s largest abortion provider fights President Donald Trump’s administration over efforts to defund the organization in his signature tax legislation.

The new order replaces a previous edict handed down by U.S. District Judge Indira Talwani in Boston last week. Talwani initially granted a preliminary injunction specifically blocking the government from cutting Medicaid payments to Planned Parenthood members that didn’t provide abortion care or didn’t meet a threshold of at least $800,000 in Medicaid reimbursements in a given year.

“Patients are likely to suffer adverse health consequences where care is disrupted or unavailable,” Talwani wrote in her Monday order. “In particular, restricting Members’ ability to provide healthcare services threatens an increase in unintended pregnancies and attendant complications because of reduced access to effective contraceptives, and an increase in undiagnosed and untreated STIs.”

A provision in Trump’s tax bill instructed the federal government to end Medicaid payments for one year to abortion providers that received more than $800,000 from Medicaid in 2023, even to those like Planned Parenthood that also offer medical services like contraception, pregnancy tests and STD testing.

Although Planned Parenthood is not specifically named in the statute, which went into effect July 4, the organization’s leaders say it was meant to affect their nearly 600 centers in 48 states. However, a major medical provider in Maine and likely others have also been hit.

In its lawsuit, Planned Parenthood had argued that they would be at risk of closing nearly 200 clinics in 24 states if they are cut off from Medicaid funds. They estimated this would result in more than 1 million patients losing care.

“We’re suing the Trump administration over this targeted attack on Planned Parenthood health centers and the patients who rely on them for care,” said Planned Parenthood’s president and CEO Alexis McGill Johnson in a statement on Monday. “This case is about making sure that patients who use Medicaid as their insurance to get birth control, cancer screenings, and STI testing and treatment can continue to do so at their local Planned Parenthood health center, and we will make that clear in court.”

The lawsuit was filed earlier this month against Health and Human Services Secretary Robert F. Kennedy Jr. by Planned Parenthood Federation of America and its member organizations in Massachusetts and Utah.

The federal department of health did not immediately respond to requests for comment.

Previously, the department said it strongly disagreed with the judge’s initial order that allowed some Planned Parenthood members to receive Medicaid funding.

“States should not be forced to fund organizations that have chosen political advocacy over patient care,” said the department’s communication director, Andrew Nixon. Doing so, he said, “undermines state flexibility” and “concerns about accountability.”

Medicaid is a government health care program that serves millions of low-income and disabled Americans. Nearly half of Planned Parenthood’s patients rely on Medicaid.

Magothy River Association member Bob Moyer said he went out to photograph a particularly large pistachio tide on Cattail Creek in October, and was so overwhelmed by the sulfur smell that he collapsed to his hands and knees and had to crawl off the pier.

Pistachio tides occur when bacteria in the river produce hydrogen sulfide, which depletes the oxygen in the water and creates a rotten smell. The bacteria produce a bright green color, which is where the name comes from.

Working with the river association, Johns Hopkins University is researching the bacterial booms in Cattail and Old Man creeks this summer to identify where and when they occur. Pistachio tides usually develop between August and October, and Hopkins started collecting water samples in early July to get ahead of the blooms.

Paul Spadaro, president of the Magothy River Association, is concerned about people breathing in the sulfur, especially on Cattail Creek, where recreational activity often takes place. Without any monitoring or warning system, kayakers may paddle into a pistachio tide.

“I do think people need to know that when you smell that sewer gas, it’s time to move away,” Spadaro said.

Part of Hopkins’ research this summer is to determine if there is a danger to wildlife or humans. Sulfur bacteria are naturally occurring, but stormwater and fertilizer runoff entering the creek can increase the pervasiveness of these bacteria by depleting oxygen.

In October, Spadaro said 380 fish in the Town Neck region of Cattail Creek were found dead during the pistachio tides. In September, a bloom in Baltimore’s Inner Harbor killed 24,000 fish. The Department of Natural Resources deploys continuous monitoring of these blooms in the Inner Harbor.

“It’s the sulfur bacteria’s appetite for oxygen that makes it dangerous to fish, crabs, eels, and other aquatic life that need dissolved oxygen to breathe,” said DNR program manager Cathy Wazniak.

However, Wazniak said that without long-term data on pistachio tides in the Chesapeake Bay, she could not say whether any trends exist.

“We’re in here for the pistachio tides, because they’re kind of falling under the radar,” said Sarah Preheim, an associate professor at Hopkins who is leading the research project.

Hopkins received a $312,000 grant in 2024 from the National Science Foundation to research microbial processes in the Chesapeake Bay. About $2,000 is going toward pistachio tide research on the Magothy River.

Preheim said rising overall temperatures and nutrient pollution contribute to pistachio tides because warmer water holds less oxygen, based on monitoring data from the Inner Harbor in the past decade.

Moyer, a Berrywood resident, hopes Preheim’s research will help educate residents about the blooms and encourage them to rethink where the rainwater on their property goes. In the Berrywood neighborhood, storm drains open right into the creek.

He says homeowners should fertilize their lawns late in the fall, if at all, when colder water holds more oxygen and is less susceptible to the damage caused by the fertilizer chemicals. He also wants more waterfront residents to consider putting native plants as a buffer between their lawn and the creek.

Preheim said she is focusing this summer on collecting water samples to help determine what environmental factors are causing the blooms, so that next year she can create a predictive model to help warn people when these pistachio tides might occur.

One possibility is to provide sulfur measuring strips to citizen scientists, such as those at the river association, so they can test the water themselves for sulfur levels.

“The people need to know if it’s really toxic,” Spadaro said.

Have a news tip? Contact Tori Newby at tnewby@baltsun.com.

SHREVEPORT, La. — When Robert Smith met his future girlfriend in 2010, he wanted to take things slowly. For Smith, no relationship had been easy in the years since he was diagnosed with the human immunodeficiency virus, or HIV. People often became afraid when they learned his status, even running away when he coughed.

The couple waited months to have sex until Smith felt he could share his medical status. To prepare her, Smith said, he took his girlfriend to his job in HIV prevention at the Philadelphia Center, a northwestern Louisiana nonprofit that offers resources to people with HIV, which also provided him housing at the time.

Finally, he revealed the news: Smith was diagnosed with HIV in 1994 and started taking daily antiviral pills in 2006. The virus could no longer be detected in his blood, and he couldn’t transmit it to a sexual partner.

Smith said his girlfriend seemed comfortable knowing his status. When it came to sex, there was no hesitation, he said. But a couple of years later, when Smith wanted to break up, he said, her tone shifted.

“She was like, ‘If you try to leave me, I’m gonna put you in jail,’” recalled Smith, now 68. “At the time, I really didn’t know the sincerity of it.”

After they broke up, she reported him to the police, accusing him of violating a little-known law in Louisiana — a felony called “intentional exposure to HIV.” He disputed the allegations, but in 2013 accepted a plea deal to spend six months in prison on the charge. He had a few months left on parole from a past conviction on different charges, and Smith thought this option would let him move past the relationship faster. He didn’t realize the conviction would also land him on the state’s sex offender registry.

For nearly two decades, Smith had dealt with the stigma associated with having HIV; the registry added another layer of exclusion, severely restricting where he could live and work to avoid minors. Not many people want to hire a sex offender, he said. Smith has been told by the local sheriff’s office he’s not allowed to do simple things, like go to a public park or a high school football game, since the conviction.

“I’ve been undetectable for 15 years, but that law still punishes us,” Smith said.

Louisiana is one of 30 states with criminal penalties related to exposing or transmitting HIV. Most of the laws were passed in the 1980s during the emergence of the AIDS epidemic. Since then, several states have amended their laws to make them less punitive or repealed them outright, including Maryland and North Dakota this year.

But Louisiana’s law remains among the harshest. The state is one of five that may require people such as Smith to register as a sex offender if convicted, a label that can follow them for over a decade. And state lawmakers considered a bill to expand the law to apply to other sexually transmitted infections, then failed to pass it before the session ended.

Meanwhile, people with HIV also face the threat that federal funding cuts will affect their access to treatment, along with prevention efforts, supportive services, and outreach. Such strategies have proved to slow the HIV/AIDS epidemic, unlike the laws’ punitive approach.

The tax and domestic policy law previously known as the “One Big Beautiful Bill” will likely affect HIV-positive people enrolled in Medicaid by reducing federal support for Medicaid and restricting eligibility. About 40% of adults under 65 with HIV rely on Medicaid.

The Trump administration proposed in its fiscal 2026 budget request to eliminate HIV prevention programs at the Centers for Disease Control and Prevention and to cancel a grant that helps fund housing for people with HIV. The Ryan White HIV/AIDS program, the largest federal fund dedicated to supporting HIV-positive people, also faces cuts. The program serves more than half of the people in the U.S. diagnosed with HIV, including in Louisiana, according to KFF, a health information nonprofit that includes KFF Health News.

Public health officials maintain that state laws criminalizing HIV exposure hurt efforts to end the HIV epidemic. Epidemiologists and other experts on AIDS agree that the enforcement of such laws is often shaped by fear, not science. For example, in many states that criminalize HIV exposure, people living with HIV can face heightened criminal penalties for actions that can’t transmit the virus, such as spitting on someone. The laws further stigmatize and deter people from getting tested and treatment, undermining response to the epidemic, experts say.

At least 4,400 people in 14 states have been arrested under these laws, though data is limited and the actual number is likely higher, and the arrests aren’t decreasing, according to analyses by UCLA’s Williams Institute.

“ Some people think it’s an issue that’s gone away, and that simply isn’t the case,” said Nathan Cisneros, a researcher at the Williams Institute.

In Louisiana, a 2022 Williams Institute analysis found at least 147 allegations reported to law enforcement under the state’s HIV law from 2011 to mid-2022. Black people made up nearly three-quarters of the people convicted and placed on the sex offender registry. Most were Black men, like Smith. At the time of the analysis, Black people made up about two-thirds of HIV diagnoses in the state.

“ We see over and over that Black people are disproportionately affected by the HIV epidemic and disproportionately affected by policing and incarceration in the United States,” Cisneros said.

Nationally, other marginalized groups such as women, sex workers, the queer community, or people who overlap across more than one group are also disproportionately arrested and prosecuted under similar criminalization laws, Cisneros said.

Ensnared in the System

Louisiana’s law hinges on the requirement that if a person knows they have HIV, they must disclose their HIV status and receive consent before exposing someone to the virus.

Louisiana District Attorneys Association Executive Director Zach Daniels said these cases don’t come up often and can be difficult to prosecute. Daniels said the intimate nature of the cases can lead to little evidence in support of either side, especially if the accuser doesn’t contract HIV.

When it comes to talking about one’s sex life, Daniels said, “there are often no other witnesses, besides the two participants.”

Louisiana’s law is written so that “intentional exposure” can occur through “any means or contact.” That includes sex and needle-sharing, practices known to transmit the virus. But the language of the law is so broad that actions known not to transmit the virus — like biting or scratching — could be included, said Dietz, the statewide coordinator for the Louisiana Coalition on Criminalization and Health, an advocacy network founded by people living with HIV that has opposed the law.

The broad nature of the law creates opportunities for abuse, as the threat of being reported under the law can be used as a coercive tool in relationships, said Dietz, who goes by one name and uses they/them pronouns. Such threats, Dietz said, have kept people in abusive relationships and loomed over child custody battles. Dietz said they’ ve supported people accused of exposing their children to HIV in ways that are not medically possible.

“ ‘Any means or contact’ could be just merely being around your kids,” they said.

The prosecutors’ organization still supports the law as a recourse for emergency responders who, in rare instances, come into contact with blood or syringes containing the virus. In one recent high-profile case in New Orleans, the law was used against a local DJ accused of knowingly transmitting HIV to several women without informing them of his status or using a condom.

The person accused of violating the law, not the accuser, must prove their case — that they disclosed their HIV status beforehand. Without a signed affidavit or tape recording, courts can end up basing their decisions on conflicting testimonies with little supporting evidence.

That’s what Smith alleged happened to him.

After his relationship ended, he said, he remembered being called into a meeting with his parole officer where a detective waited for him, asking about his former relationship and whether his girlfriend had known about his HIV status.

Smith said yes. But that’s not what she had told police.

Verite News could not find a working phone number for Smith’s former girlfriend but corroborated the story with the incident’s police report. His attorney at the time, a public defender named Carlos Prudhomme, said he didn’t remember much about the case, and court documents are sealed because it was a sex offense.

In court, it was her word against his. So when he was offered six months in prison instead of the 10-year maximum, he switched his plea from not guilty to guilty. But he said he didn’t know his new conviction would require him to register as a sex offender once he got out — worsening the stigma.

“When people see ‘sex offender,’ the first thing that comes to their mind is rape, child molester, predator,” Smith said. “This law puts me in a category that I don’t care to be in.”

He has tried to make the most of it, despite the expense of paying fees each year to reregister. After being rejected from jobs, he started a catering business and built a loyal clientele. But he said he’s still stuck living in a poorly maintained apartment complex primarily inhabited by sex offenders.

“I understand their strategy for creating this law to prevent the spread, but it’s not helping. It’s hurting; it’s hindering. It’s destroying people’s lives instead of helping people’s lives, especially the HIV community,” he said. “They don’t care about us.”

The Case for Reform

Since 2014, there has been a nationwide effort to update or repeal state laws that criminalize HIV nondisclosure, exposure, or transmission. A dozen states have changed their laws to align more closely with modern science, and four have gotten rid of them completely in hopes of reducing stigma and improving public health outcomes, according to the Center for HIV Law and Policy.

Sean McCormick, an attorney with the center, said these changes are influenced partly by a growing body of evidence showing the laws’ negative consequences.

McCormick said the laws offer a “clear disincentive” for people to get tested for HIV. If they don’t know their status, there’s no criminal liability for transmission or exposure.

A 2024 survey by Centers for Disease Control and Prevention and DLH Corp. researchers found that after California updated its HIV criminalization law in 2018, respondents were more likely to get tested. Meanwhile, survey respondents in Nevada, which still had a more punitive law on the books, were less likely to get tested.

There’s no one-size-fits-all solution, McCormick said. His center works with HIV-positive people across the country to determine what legislative changes would work best in their states.

Texas was the first to repeal its HIV law in 1994.

“As a person living with HIV in Texas, I’m deeply appreciative that we don’t have an HIV-specific statute that puts a target on my back,” said Michael Elizabeth, the public health policy director for the Equality Federation.

But Elizabeth points out that Texans living with HIV still face steeper penalties under general felony laws for charges such as aggravated assault or aggravated sexual assault after state courts in Texas equated the bodily fluids of a person with HIV with a “deadly weapon.”

Louisiana activists have pushed lawmakers in the state to amend the law in three ways: removing the sex offender registration requirement, requiring transmission to have occurred, and requiring clear intent to transmit the virus.

“Our strategy, as opposed to repeal, is to create a law that actually addresses the kind of boogeyman that they ostensibly created the law for: the person who successfully, maliciously, intentionally transmits HIV,” said Dietz with the Louisiana Coalition on Criminalization and Health.

In 2018, a bill to narrow the statute was amended in ways that expanded the law. For example, the updated law no longer had any definition of which actions “expose” someone to HIV.

In 2023, state lawmakers created a task force that recommended updating Louisiana’s law to align with the latest public health guidelines, limit the potential for unintended consequences, and give previously convicted people a way to clear their record.

Lawmakers in the state House pushed forward a bill this year to criminalize other sexually transmitted infections, including hepatitis B and the herpes simplex virus. That bill died in the Senate, but it spurred the creation of another legislative task force with a nearly identical mission to that of the first.

“ This state has no idea how closely we just dodged a bullet,” Dietz said.

In the meantime, the Louisiana coalition is helping Smith petition the state to take his name off the sex offender registry. Louisiana law allows people to petition to have their names removed from the registry after 10 years without any new sex crime convictions. Smith expects his case to be approved by the end of the year.

Despite the difficulty of the past 12 years, he said, he’s grateful for the chance to be free from the registry’s restrictions.

“It’s like a breath of fresh air,” Smith said. “I can do stuff that I wanted to do that I couldn’t. Like, go to a football game. Simple stuff like that, I’m going to be ready to do.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

Mike Gimbel, a longtime advocate for drug treatment and former heroin addict himself, says the real solution is being ignored: long-term access to treatment.

“The demand for drug treatment beds is enormous,” Gimbel said. “This is where Baltimore and the state of Maryland have fallen on their face.”

Gimbel, who has been in recovery for nearly 53 years, said the current strategies being used by city and state leaders are falling short. He’s calling them out publicly for what he calls a failure in the fight against addiction.

“What you’re seeing on the city and state level, it’s not acceptable,” Gimbel said. “It’s embarrassing, actually.”

Gimbel is a familiar face to many from his time on FOX45 News’ Straight Talk with Mike Gimbel. He says open-air drug markets in Baltimore are thriving because there’s little incentive for users to change.

“Giving clean needles and Narcan and test strips does not change behavior,” he said. “If you don’t change the behavior of the addict, you may bring them back from an overdose death, but eventually, they’re going to come back.”

He argues that lasting recovery depends heavily on changing a person’s environment — including where they live and who they’re surrounded by.

Drug courts, which can provide court-ordered treatment in place of jail time, are a step in the right direction, he said. But they also face an obstacle.

“The concept of drug court has always been very successful,” Gimbel said. “The problem with drug court is there’s not enough places to send people.”

Without treatment, Gimbel said, many drug users face the same outcome of death.

According to a recent report from The Baltimore Sun, nearly 90% of Maryland’s deaths classified as “undetermined” in 2023 were drug-related. A Johns Hopkins medical director said that an estimated two-thirds of those deaths were accidental overdoses.

Baltimore City had the highest number in the state, with 442 undetermined deaths in 2023.

Spotlight on Maryland reviewed similar data from cities facing parallel struggles. In St. Louis, Missouri, there were 12 undetermined deaths reported in 2023 — only two of which involved drugs, according to the medical examiner’s office. In Oakland, California, there were just four undetermined deaths last year.

Baltimore recently received $400 million in opioid settlement funds from pharmaceutical companies. Gimbel said some of that money should be used to expand treatment options.

Spotlight on Maryland is a collaborative project by FOX45 News, WJLA in Washington, D.C., and The Baltimore Sun. Have a tip or story idea? Contact Tessa Bentulan at tbentulan@sbgtv.com.

Every time Ashton Alexander sees an ad for Georgia Pathways to Coverage, it feels like a “kick in the face.”

Alexander tried signing up for Pathways, the state’s limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he’s a full-time student.

Georgia is one of 10 states that haven’t expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they’re working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. And it is the only state currently doing so.

“Why is this marketing out here?” said the 20-year-old, who lives in Conyers, east of Atlanta. “It’s truly not accessible.”

Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn’t connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine.

“It’s impenetrable,” Alexander said. “I’ve literally tried everything, and there’s no way.”

Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements.

Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation’s only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia’s budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 are already working or have a barrier that prevents them from doing so.

What Georgia shows is “just how costly setting up these administrative systems of red tape can be,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

Over the past two years, KFF Health News has documented the issues riddling Georgia’s Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act.

The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports.

“That was truly a pretty shocking waste of taxpayer dollars,” Alker said.

The Government Accountability Office is investigating the costs of the program after a group of Democratic senators — including both members of the Georgia delegation — asked the government watchdog to look into the program. Findings are expected this fall.

A state report to the federal government from March said Georgia couldn’t effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn’t suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways.

The Pathways program has strained Georgia’s eligibility system for other public benefits, such as food stamps and cash assistance.

In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn’t help enrollees find jobs.

“Georgia’s experience shows that administrative complexity is the primary outcome, not job readiness,” said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care.

Despite the struggles, Garrison Douglas, a spokesperson for Georgia’s Republican governor, Brian Kemp, defended the program. “Georgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities,” he said in an emailed statement.

New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file.

The federal law includes exemptions for people with disabilities, in addiction treatment, or caring for kids under 14, among others.

The Trump administration said other states won’t face a bumpy rollout like Georgia’s.

“We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements,” said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement.

In a written public comment on Georgia’s application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll.

She said she tried to sign up several times but that her application was not accepted. “Not once, not twice, but 3 times. With no response from customer service,” she wrote in February. “So now I am without coverage.”

Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn’t exempt caregivers of older adults.

“Georgia should recognize their sacrifices by supporting them with health insurance,” she wrote. “Let’s simplify this system and in the end, save money and lives.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

Dr. Ausim Azizi is among those seeing the overall early results, as Yale New Haven Hospital is in the forefront of research and clinical care, he said, calling it “tops in the country,” and home to a federally-funded Alzheimer’s Disease Research Center.

“We have started 350 people on these drugs,” he said. “Everybody I see feels better,” and feels, along with their families that they have “more control” of their lives.

With easy early detection and treatment patients may never reach the end stage of the disease, he said. The medication slows the disease progression and maintains what patients have, longer, he said.

In terms of quality of life, someone 75 years old, retired with significant memory problems, can still have friends and, “a good life,” with early detection and treatment, Azizi said.

The debilitating, progressive condition robs sufferers of their memory and cognitive abilities.

Azizi said there is no cure for Alzheimer’s, but the disease can be “modified” with medications from two different companies.

The medications approved about two years ago are Lecanemab, also known as Leqembi and Kisunla, also known as Donanemab. The drugs are administered through an IV infusion that targets amyloid plaque in the brain.

Azizi said confirmation of Alzheimer’s, as opposed to other forms of dementia, is needed to treat with those medications and, until the blood test diagnosis, was complicated, stressful, and expensive, Azizi said.

The blood test, Lumipulse G, for Alzheimer’s Disease, approved in late May, can confirm the disease with 98 percent accuracy, he said.

Prior to the blood test, doctors confirmed the disease by drawing spinal fluid to test for chemicals or through a pet scan, Azizi said.

The blood test is not predictive and the test is for people 55 and older suffering cognitive issues, he said. Confirmation of Alzheimer’s is needed for the medication to be prescribed.

That early detection is key, he said, because while the medications don’t cure Alzheimer’s, they slow progression.

According to the Alzheimer’s Association, it is a progressive disease, “where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment.

“On average, a person with Alzheimer’s lives four to eight years after diagnosis but can live as long as 20 years, depending on other factors,” according to the association.

The association notes that its “2025 Alzheimer’s Disease Facts and Figures” report found that “nearly 4 in 5 Americans would want to know if they had Alzheimer’s disease before it impacted their lives,” which means “91% of Americans say they would want to take a simple test — such as a blood biomarker test — if it were available,” because that would then open access to early treatment.

Azizi said that, in Alzheimer’s, sticky proteins or plaques are found on the brain that he likened to rust on an engine.

“The wheels don’t turn, things are squeaky,” he said.

People with the plaques have trouble with cognition, sequencing events and their memory noticeably going, he said.

The new medications “clear the rust,” and slow progression, but the damage already done remains, he said.

Cognitive problems can develop with other forms of dementia, but the same medications don’t work for those. He said 70 percent of the time when there are cognitive problems, it’s Alzheimer’s.

“Before we treat we ask, do you have biologic evidence?,” Azizi said.

He said of early treatment, “It’s huge for the family.”

Simple lifestyle changes can also improve outcomes, he said.

He said 10 factors that boost the brain and help prevent dementia include:

• Control blood pressure, low number should be below 80
• Control blood sugar to around 100
• Control cholesterol, total fasting less than 200
• Adequate and restful sleep
• Diet, eat mostly unprocessed plants
• Maintain a healthy body weight
• If you are smoking, stop
• Reduce alcohol intake – maximum of 3 to 4 drinks per week
• Increase physical activity, including daily aerobic exercise
• Engage in enjoyable and healthy social and mental activities

They frequently talk over each other and interrupt people all the time because they can’t seem to tell if someone else is speaking.

What’s really annoying is they keep telling me to speak up, then complain when I do so. They accuse me of mumbling, but everyone else understands me just fine.

I have to repeat myself over and over again, increasing my volume each time until they say, “don’t yell at me!”

I keep telling them that if they keep asking me to speak up until they can hear me, they shouldn’t complain when I finally reach a volume they can hear. Any thoughts?

— Raising Voices

Dear Voices: Navigating hearing loss can be tough. Sometimes it’s an issue of pride, sometimes people don’t realize how much they’re missing and have gotten used to getting by. It can be difficult to convince friends who haven’t found the right medical solution to keep trying.

But, in a non-charged moment, talk to them about what you’re seeing and encourage them to visit an audiologist, perhaps a different one than the doctor they saw before. Remind them that hearing loss is associated with an increased risk of developing dementia and that, according to the National Institute of Health, using hearing aids can help reduce the rate of cognitive decline in older adults by up to 50 percent. Additionally, hearing aids can help reduce social isolation by helping those experiencing hearing loss to better engage with conversation and the world around them. There are many benefits, but like many medical remedies, they sometimes take a minute to get used to.

Perhaps by focusing on their personal well-being and continued health, you’ll help them see that you’re not complaining simply for the sake of complaining, but rather because you want the best for them and for your friendship.

Dear Eric: My ex-husband and I have been divorced for more than 20 years. We see each other at family functions and are very cordial and polite with each other, as I am to his girlfriend, who attends them all.

Neither of us remarried. He has been in this relationship with this female for many years but they don’t live together.

When our sons had their first babies (a boy and a girl, now 9) my ex wanted the family to refer to his girlfriend as Nonna. Our sons immediately shut that idea down, stating that their children have a grandmother and that they would refer to his girlfriend by her first name out of respect for their mother and especially not to confuse the children.

Recently, while attending an afternoon visit at one of my son’s, my daughter-in-law and I were having a conversation about my 9-year-old grandson while he was in the backyard with his dad and 6-year-old brother. In the conversation my DIL was relaying something that my grandson said about my ex-husband’s girlfriend and referred to her as “Nonna.”

Immediately, I asked “is he referring to his grandfather’s girlfriend as Nonna now?” He never had before nor had anyone else in the family. She replied “yes!”

I immediately said that I was not comfortable with that and that it really bothers me since I am clearly not dead. (And don’t plan to go anywhere any time soon.)

Here’s my question: Is there an unwritten rule for living grandmothers who have a great relationship with their grandchildren and their grandfathers’ girlfriends who want to share that very special title. (By the way, said girlfriend already has enough of her very own grandchildren)

— Carissima Nonna

Dear Nonna: The problem with unwritten rules is — you guessed it — they’re not recorded in writing, so time and circumstance tend to shift them around. Now, you made your preference clear, and your son and daughter-in-law honored that, but somehow things have shifted.

Obviously, I can’t say for sure, but it’s possible that your grandson has started to think of grandmother figures in general as Nonnas and is using it as a blanket term, rather than a specific term of endearment for you. Any of the adults involved could have provided an alternative (“Oh, I’m Nonna Stephanie,” or what-have-you) and it would’ve saved some consternation. But, somehow, they didn’t.

So, try to re-frame the situation as it stands currently. Your relationship with your grandson remains unique and special. You’re not being replaced nor forgotten. I know the name has special meaning for you, but, as with Grandma or Grammy or any other nomenclature, try to remember that he’ll always know which one he’s calling when he uses it, and the history and future of each relationship will always be distinct.

(Send questions to R. Eric Thomas at eric@askingeric.com or P.O. Box 22474, Philadelphia, PA 19110. Follow him on Instagram and sign up for his weekly newsletter at rericthomas.com.)

As artificial intelligence technology becomes part of daily life, adolescents are turning to chatbots for advice, guidance and conversation. The appeal is clear: Chatbots are patient, never judgmental, supportive and always available.

That worries experts who say the booming AI industry is largely unregulated and that many parents have no idea about how their kids are using AI tools or the extent of personal information they are sharing with chatbots.

New research shows more than 70% of American teenagers have used AI companions and more than half converse with them regularly. The study by Common Sense Media focused on “AI companions,” like Character. AI, Nomi and Replika, which it defines as “digital friends or characters you can text or talk with whenever you want,” versus AI assistants or tools like ChatGPT, though it notes they can be used the same way.

It’s important that parents understand the technology. Experts suggest some things parents can do to help protect their kids:

— Start a conversation, without judgment, says Michael Robb, head researcher at Common Sense Media. Approach your teen with curiosity and basic questions: “Have you heard of AI companions?” “Do you use apps that talk to you like a friend?” Listen and understand what appeals to your teen before being dismissive or saying you’re worried about it.

— Help teens recognize that AI companions are programmed to be agreeable and validating. Explain that’s not how real relationships work and that real friends with their own points of view can help navigate difficult situations in ways that AI companions cannot.

“One of the things that’s really concerning is not only what’s happening on screen but how much time it’s taking kids away from relationships in real life,” says Mitch Prinstein, chief of psychology at the American Psychological Association. “We need to teach kids that this is a form of entertainment. It’s not real, and it’s really important they distinguish it from reality and should not have it replace relationships in your actual life.”

The APA recently put out a health advisory on AI and adolescent well-being, and tips for parents.

— Parents should watch for signs of unhealthy attachments.

“If your teen is preferring AI interactions over real relationships or spending hours talking to AI companions, or showing that they are becoming emotionally distressed when separated from them — those are patterns that suggest AI companions might be replacing rather than complementing human connection,” Robb says.

— Parents can set rules about AI use, just like they do for screen time and social media. Have discussions about when and how AI tools can and cannot be used. Many AI companions are designed for adult use and can mimic romantic, intimate and role-playing scenarios.

While AI companions may feel supportive, children should understand the tools are not equipped to handle a real crisis or provide genuine mental health support. If kids are struggling with depression, anxiety, loneliness, an eating disorder or other mental health challenges, they need human support — whether it is family, friends or a mental health professional.

— Get informed. The more parents know about AI, the better. “I don’t think people quite get what AI can do, how many teens are using it and why it’s starting to get a little scary,” says Prinstein, one of many experts calling for regulations to ensure safety guardrails for children. “A lot of us throw our hands up and say, ‘I don’t know what this is!’ This sounds crazy!’ Unfortunately, that tells kids if you have a problem with this, don’t come to me because I am going to diminish it and belittle it.”

Older teenagers have advice, too, for parents and kids. Banning AI tools is not a solution because the technology is becoming ubiquitous, says Ganesh Nair, 18.

“Trying not to use AI is like trying to not use social media today. It is too ingrained in everything we do,” says Nair, who is trying to step back from using AI companions after seeing them affect real-life friendships in his high school. “The best way you can try to regulate it is to embrace being challenged.”

“Anything that is difficult, AI can make easy. But that is a problem,” says Nair. “Actively seek out challenges, whether academic or personal. If you fall for the idea that easier is better, then you are the most vulnerable to being absorbed into this newly artificial world.”

The Associated Press’ education coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

No question is too small when Kayla Chege, a high school student in Kansas, is using artificial intelligence.

The 15-year-old asks ChatGPT for guidance on back-to-school shopping, makeup colors, low-calorie choices at Smoothie King, plus ideas for her Sweet 16 and her younger sister’s birthday party.

The sophomore honors student makes a point not to have chatbots do her homework and tries to limit her interactions to mundane questions. But in interviews with The Associated Press and a new study, teenagers say they are increasingly interacting with AI as if it were a companion, capable of providing advice and friendship.

“Everyone uses AI for everything now. It’s really taking over,” said Chege, who wonders how AI tools will affect her generation. “I think kids use AI to get out of thinking.”

For the past couple of years, concerns about cheating at school have dominated the conversation around kids and AI. But artificial intelligence is playing a much larger role in many of their lives. AI, teens say, has become a go-to source for personal advice, emotional support, everyday decision-making and problem-solving.

‘AI is always available. It never gets bored with you’

More than 70% of teens have used AI companions and half use them regularly, according to a new study from Common Sense Media, a group that studies and advocates for using screens and digital media sensibly.

The study defines AI companions as platforms designed to serve as “digital friends,” like Character. AI or Replika, which can be customized with specific traits or personalities and can offer emotional support, companionship and conversations that can feel human-like. But popular sites like ChatGPT and Claude, which mainly answer questions, are being used in the same way, the researchers say.

As the technology rapidly gets more sophisticated, teenagers and experts worry about AI’s potential to redefine human relationships and exacerbate crises of loneliness and youth mental health.

“AI is always available. It never gets bored with you. It’s never judgmental,” says Ganesh Nair, an 18-year-old in Arkansas. “When you’re talking to AI, you are always right. You’re always interesting. You are always emotionally justified.”

All that used to be appealing, but as Nair heads to college this fall, he wants to step back from using AI. Nair got spooked after a high school friend who relied on an “AI companion” for heart-to-heart conversations with his girlfriend later had the chatbot write the breakup text ending his two-year relationship.

“That felt a little bit dystopian, that a computer generated the end to a real relationship,” said Nair. “It’s almost like we are allowing computers to replace our relationships with people.”

How many teens are using AI? New study stuns researchers

In the Common Sense Media survey, 31% of teens said their conversations with AI companions were “as satisfying or more satisfying” than talking with real friends. Even though half of teens said they distrust AI’s advice, 33% had discussed serious or important issues with AI instead of real people.

Those findings are worrisome, says Michael Robb, the study’s lead author and head researcher at Common Sense, and should send a warning to parents, teachers and policymakers. The now-booming and largely unregulated AI industry is becoming as integrated with adolescence as smartphones and social media are.

“It’s eye-opening,” said Robb. “When we set out to do this survey, we had no understanding of how many kids are actually using AI companions.” The study polled more than 1,000 teens nationwide in April and May.

Adolescence is a critical time for developing identity, social skills and independence, Robb said, and AI companions should complement — not replace — real-world interactions.

“If teens are developing social skills on AI platforms where they are constantly being validated, not being challenged, not learning to read social cues or understand somebody else’s perspective, they are not going to be adequately prepared in the real world,” he said.

The nonprofit analyzed several popular AI companions in a “ risk assessment,” finding ineffective age restrictions and that the platforms can produce sexual material, give dangerous advice and offer harmful content. The group recommends that minors not use AI companions.

A concerning trend to teens and adults alike

Researchers and educators worry about the cognitive costs for youth who rely heavily on AI, especially in their creativity, critical thinking and social skills. The potential dangers of children forming relationships with chatbots gained national attention last year when a 14-year-old Florida boy died by suicide after developing an emotional attachment to a Character. AI chatbot.

“Parents really have no idea this is happening,” said Eva Telzer, a psychology and neuroscience professor at the University of North Carolina at Chapel Hill. “All of us are struck by how quickly this blew up.” Telzer is leading multiple studies on youth and AI, a new research area with limited data.

Telzer’s research has found that children as young as 8 are using generative AI and also found that teens are using AI to explore their sexuality and for companionship. In focus groups, Telzer found that one of the top apps teens frequent is SpicyChat AI, a free role-playing app intended for adults.

Many teens also say they use chatbots to write emails or messages to strike the right tone in sensitive situations.

“One of the concerns that comes up is that they no longer have trust in themselves to make a decision,” said Telzer. “They need feedback from AI before feeling like they can check off the box that an idea is OK or not.”

Arkansas teen Bruce Perry, 17, says he relates to that and relies on AI tools to craft outlines and proofread essays for his English class.

“If you tell me to plan out an essay, I would think of going to ChatGPT before getting out a pencil,” Perry said. He uses AI daily and has asked chatbots for advice in social situations, to help him decide what to wear and to write emails to teachers, saying AI articulates his thoughts faster.

Perry says he feels fortunate that AI companions were not around when he was younger.

“I’m worried that kids could get lost in this,” Perry said. “I could see a kid that grows up with AI not seeing a reason to go to the park or try to make a friend.”

Other teens agree, saying the issues with AI and its effect on children’s mental health are different from those of social media.

“Social media complemented the need people have to be seen, to be known, to meet new people,” Nair said. “I think AI complements another need that runs a lot deeper — our need for attachment and our need to feel emotions. It feeds off of that.”

“It’s the new addiction,” Nair added. “That’s how I see it.”

The Associated Press’ education coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.