For years, stories circulated around Joplin, Missouri, about the city’s homeless population and how they arrived in the city. 

Calls would come in to city officials following a recurring theme. 

“People were coming to the City Council meetings and saying, ‘I don’t know why you guys don’t know this, but I’m witnessing busloads of people being dropped off in our town,’” said Joplin Mayor Keenan Cortez. “‘Buses are coming in, stopping at gas stations, unloading and the buses are turning around and going back.’” 

The city commissioned a study to investigate. But it came back with no hard evidence. 

Still, the reports kept coming in. So the city took a deeper look.

Officials collected video evidence of out-of-state law enforcement vehicles dropping people off at truck stops. Some medical systems seemed to be involved, too. They also gathered signed affidavits from people who were new to Joplin, saying they were given promises of a shelter bed or resources at the end of their ride. 

“We were starting to hear from people in our community that, ‘I was brought to Joplin and just dropped off. I was in trouble over there. That community didn’t deal with me. They put me in a car, a van, a bus and said there’s help for you,’” Cortez said. 

Instead, they were left without their support system, in a new city with limited resources and few places to turn. 

Cortez said city officials aren’t sure how many people shared similar stories. 

“At the end of the day, I don’t know if it was 15, if it was 50,” Cortez said. “As a mayor, it doesn’t matter.” 

Joplin officials put their heads together with the city’s legal team. After sending cease-and-desist letters to the organizations they believed were dropping people off in the city, the City Council started considering legislation to ban the practice. 

The City Council passed an ordinance at the beginning of November. It isn’t uncommon for medical systems to refer patients needing specialized treatment, or for victims of domestic violence, to be sent to a shelter in another town. The ordinance includes exemptions for those situations. 

So far, Cortez and city officials think the letters and new ordinance appear to be working. They haven’t had any reports of people being dropped off since the ordinance was passed. But the trend points to a larger problem Missouri’s cities are facing as homelessness rises across the state. 

Missouri’s reliance on larger cities for services for the homeless population

It is fairly common for smaller, rural areas to rely on the services in larger cities for things like shelters, medical care or mental health treatment. 

From 2023 to 2024, the number of unsheltered people grew 9% in Missouri, according to the U.S. Department of Housing and Urban Development point-in-time counts. In Kansas, the number grew by 6%, while Oklahoma saw an 18% jump. 

Columbia is similar to Joplin when it comes to being a regional hub for services and shelter beds. 

Columbia began working more closely on reducing homelessness in 2023 by establishing a program within Boone County’s Department of Public Health to connect people with resources. City officials also created a homeless outreach team within the police department to try and divert people from the justice system. 

Now, the city has launched the Ride Home program, which gives homeless or impoverished community members free rides back to their hometowns or to support systems up to three hours away. If someone needs to travel farther, the city will purchase a bus ticket to get them to where they need to go. 

Since the launch in October, the city has provided three rides, said Austin Krohn, public information specialist at the Columbia & Boone County Department of Public Health and Human Services. 

“People come in for mental health services, or if there is a facility that can only do a certain type of screening for them,” Krohn said. “People are coming here from all over Missouri to get services, and then they’re stuck here.” 

Local service providers and shelters can refer people to the program to receive a free ride. People must have verifiable support at the destination, a referral, photo ID and no outstanding warrants in the county. 

Studies have shown that voluntary transport to a support system can be instrumental in improving someone’s housing situation. 

San Francisco runs a robust transportation program, similar to Ride Home in Columbia. In fiscal year 2024, the agency that runs the program gave 230 rides. 

San Francisco officials followed up with riders 90 days after their ride, and found that of the 230 served, 61 found housing, while 29 had another or unknown location. The remaining riders were unreachable or declined to be surveyed as part of the program. 

“When I was doing direct service 30 years ago, people called it Greyhound therapy,” said Jeff Olivet, the former executive director of the U.S. Interagency Council on Homelessness. “Get a bus ticket to another town, just get out of here, basically. Sometimes that can be incredibly helpful if people are really wanting and needing to get back to family and social supports.” 

But if someone is transported or coerced to leave town against their will, it can lead to poorer outcomes, Olivet said. 

“Transportation can be critical,” Olivet said. “But if it’s basically, ‘Get out of town or we’re going to arrest you,’ that doesn’t solve homelessness for anybody. It just moves the problem around.” 

One 2023 study modeled over 20 U.S. cities concluded that involuntary displacement of people experiencing homelessness — things like encampment sweeps or involuntary transport to another area — could lead to substantial increases in morbidity and mortality. 

The study linked involuntary displacement with worse outcomes for overdoses and hospitalizations and a decrease in getting connected with treatment for opioid use. It said the displacements could contribute to deaths of homeless people who use drugs. 

A 2017 investigation from The Guardian analyzed nearly 35,000 relocation journeys over a six-year period. The investigation found that most riders were relocated to places with a lower median income. 

How Missouri fares 

And as homelessness rates rise across all of Missouri, cities may need to start thinking about how to address these gaps, Olivet said. 

“In the case of rural areas, or even suburban areas, where there aren’t as many shelter options for people, there aren’t as many mental health treatment programs, there aren’t as many supportive services. Oftentimes, the only way to get help is by going to a larger urban area,” Olivet said. 

“That speaks to a tremendous gap when we don’t have good services, support and housing options for people in rural areas. They have to go somewhere else, even if they are from that rural area.” 

In Missouri, the numbers aren’t improving. 

The state’s continuum of care — a group of agencies that work under the U.S. Department of Housing and Urban Development to address homelessness — found in its most recent report that homelessness is rapidly increasing across the state. 

In Region 9, which includes the southwest corner of the state (but does not include metro areas like Joplin or Springfield, which run their own continuums of care outside of the statewide framework), 2023 data found a 133% rise in unsheltered homelessness and a 100% rise in sheltered homelessness from 2022 to 2023. 

The area also saw family homelessness increase by 100% from 2022 to 2023. 

Region 10, which represents the counties surrounding the Kansas City area, 2023 point-in-time data showed a 3% increase in unsheltered homelessness and a 119% increase in sheltered homelessness from 2022. Family homelessness increased by 173%. 

In the group’s annual report, every region saw at least one metric of homelessness, sheltered or unsheltered, increase from 2022 to 2023. 

It rings alarm bells with Mary Kenion, the chief equity officer at the National Alliance to End Homelessness. 

“At least half of all people experiencing homelessness in largely rural continuums of care do so outdoors, in unsheltered locations,” Kenion said. “We’re also seeing family homelessness on the rise, in rural communities specifically.” 

And in their report, the Missouri continuum of care providers noted that while larger towns were better equipped to handle homelessness, it highlights the lack of resources in more rural areas. 

The report found a positive relationship between the number of beds available in permanent housing situations and the length of time someone was homeless. For every 1% increase in permanent housing beds, there was a 54-day decrease in the length of time someone was homeless. 

Although solutions like access to permanent housing show promise, roadblocks remain. 

A coalition of nonprofits and local governments recently sued the Trump administration, arguing it created unreasonable restrictions on state continuums of care across the country. The lawsuit argues that the administration is looking to shift funding away from proven solutions that improve homelessness and that it could force up to 170,000 Americans into homelessness. 

The new rules change what types of projects are eligible for funding through the U.S. Department of Housing and Urban Development, the criteria for selecting projects and the conditions grantees have to accept to receive the funding, the lawsuit argues. 

Ultimately, Joplin Mayor Cortez and other experts said that following up with someone after they receive care or resources is key in reducing homelessness.

Cortez is excited about a new development of 16 tiny homes dedicated to providing permanent housing situations for Joplin. But addressing the issue takes everyone coming together, he said. 

“This is an ongoing thing that everybody in the community is involved in —– the health care community, the religious community,” Cortez said. “We have some passionate champions in our community working to resolve this problem.” 

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When Makeesha Munro and her partner Travis Jones started their farm in Collins, Missouri, they didn’t expect to be traveling across the state to sell the culinary mushrooms they grow. 

Jones was semiretired and looking for a way to leverage their property for additional income. One night, they decided to dive into farming mushrooms. After a few late-night online purchases, Root 54 Farm was up and running. 

They made some mistakes along the way. But with the help of a now-defunded program from the U.S. Department of Agriculture, they spend almost 15 hours a week traveling to various farmers markets and selling to other buyers in Sedalia, Joplin and Springfield. 

“Owning a business is overwhelming,” Jones said. “Farming is overwhelming. When the two come together, it’s super overwhelming. So we are really grateful to people who help.” 

The Heartland Regional Food Business Center was a part of a Biden administration program aimed at increasing the resilience of local food systems following the COVID-19 pandemic. The program aimed to help small and midsized farms with things like market access and technical assistance to help them grow and maintain their businesses.

But under Trump administration budget cuts, USDA terminated the program. 

Now, its leaders are figuring out how to move forward under a new moniker — the Heartland Regional Food Business Coalition — and without the millions of dollars in federal funding once used to support their work. 

The program reimbursed farmers for big purchases and helped make connections between farmers and potential buyers. Jones and Munro were never selected for monetary support, but the connections they made helped their business take off. 

“We met a lot of the people we needed to meet,” Jones said. 

What’s next for the regional food business centers? 

Heartland was one of a handful regional food business centers established by the USDA. It officially launched in 2023 to help farmers across Missouri, Kansas, Iowa, Nebraska, Oklahoma and some Arkansas counties. 

The group was slated to get $25 million in funding over four years. But it only made one round of grants to farmers before the rest of the funding was rescinded this summer. 

In the only round of grant funding under USDA, Heartland provided nearly $4 million in financial assistance to 90 farmers after receiving nearly 500 applications from across the region. 

Heartland was preparing for the second round of Business Builder grants — nearly $9 million in funding — and expected over 1,000 farmers to apply. Instead, it got word that federal funds may be pulled. 

The group and its farmers ended up waiting six months to see if that money would actually be paid out. 

One farmer was a sunflower producer who was looking for funds to upgrade his packaging process. 

“He was ready and poised to expand his market this year,” said Katie Nixon, who currently shepherds the coalition through New Growth, a rural community development corporation in El Dorado Springs, Missouri. 

Because the funding comes as reimbursements, farmers had to make the upgrades before they could see any of the money. 

“You’re paralyzed — you’ve gotten this grant and they say, ‘If you spend the money, you’re not going to get reimbursed,’” Nixon said. “So do you say, ‘Well forget it, I’m just going to go my own way and lose $50,000, or do you wait?’” 

Along with programs like Local Food for Schools, which was also eliminated earlier this year, the federal initiative was part of a larger effort to promote local food systems across the country. 

“They took the conditions of the region and really focused to amplify that to provide an unmet demand from the rest of the nation,” said Hannah Quigley, a policy specialist at the National Sustainable Agriculture Coalition. “They were investing in scaling very regional specialized products.” 

Support from the regional centers across the country resulted in more than 2,600 new partnerships between farmers and buyers, a June 2024 USDA brief said. 

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The June data also showed the program taking off. Farmers were starting to report improved processing, distribution, storage and aggregation of regional food products as a result of the support from their regional centers under the initiative. 

Part of the reason for the success is because the money was there to actually keep people involved in the conversation. There are so many demands on small farmers, Nixon said. Without the possibility of some financial support, it can be difficult to prioritize where to spend your time. 

“This just helped (relationships) become stronger and more formalized, because you had money to help keep people at the table,” Nixon said. 

“We know that a lot of food and farm businesses came to us for technical assistance because they saw the Business Builder opportunity,” Nixon said. “So having that funding to be able to offer really gets people motivated.” 

Only a small portion of federal farm support goes to producers of specialty crops, which includes produce like fruits and vegetables or nursery crops, Quigley said. 

In the 1970s, the U.S. was a net exporter of those specialty crops. By the mid-1990s, it became a net importer. Still, in 2020 speciality crops contributed nearly $54 billion to U.S. agriculture’s $363 billion in cash receipts, USDA data from 2022 show. 

“We have plenty of land and the way that our food system is organized right now, with commodity crops — most of those are grown specifically to send somewhere else to export,” Nixon said. “What if even just a sliver of that energy was actually to domesticate real food products?” 

For smaller farmers, having dedicated support for funding and market access could make a huge difference in their success. 

Heartland hosts monthly new farmer calls and connects farmers with established mentors to help them grow their specialty crop. 

“They were connecting these farmers who might not have immediately known how to get connected to a distributor,” Quigley said. “I think a farmer could figure it out, but it might take them two full years, potentially three different growing seasons … to figure it out.” 

From July 2023 to June 2024, the centers nationwide formalized more than 250 partnerships for their farmers. In the last six months of 2024, they finalized 466. 

They were trying to reach the farmers who traditionally don’t receive USDA loans, Nixon said. 

Nixon and her colleagues are looking for sources to make up for some of the lost USDA funding. But what exactly that will mean is still unclear. 

“Local food is not easy,” Nixon said. “We’re trying to make it easier.” 

How to build out a regional food system 

Part of the difficulty in building up more regional food systems comes from connecting farmers to wholesale buyers who need large quantities of produce. 

That was some of what the regional centers were aiming to address. 

“In some cases, they connected small farmers to an aggregator, or someone who brokered purchases, then they were able to aggregate them, buy from all these small farmers and then sell to a single buyer,” Quigley said. 

That structure could help incentivize larger purchasers like food banks, states or school districts to buy more local food. 

Because of the control wholesale grocery suppliers have over those markets, it can be more difficult for businesses to stray away from what has become the mainstream model for buying food. 

Quigley pointed to agreements the USDA has with states that let states take a more hands-on approach to local food purchasing. 

“That brings those contracts down from a national scale or a 12-state scale, down to a single-state scale,” Quigley said. “It allows for a greater number of farmers and businesses to be able to successfully bid on those contracts. They don’t have to have a distribution network to serve 12 states, they can just serve a single state.” 

A 2020 local food marketing survey found that the number of farms selling locally produced food fell by 12% nationwide from 2015 to 2020. 

Still, Missouri is seeing some growth when it comes to produce farmers. The 2022 Census of Agriculture in Missouri found that the number of farms working in greenhouse, nursery and floriculture production had grown to 485 in 2022, up from 348 in 2017. 

In 2021, more than 90% of the farms selling food directly to consumers were considered small farms. 

“When you buy from somebody local, your money stays local,” Munro said. “When you’re in the local food business, you really get to know people, and we really do support each other. It’s part of what I love, it is a community.” 

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In 2025, almost everyone is online. Overnight shipping, online bill pay and endless streaming services are at our fingertips. 

And as technology and society shift to meet those changes, people living in rural Missouri don’t want to be left out of the conversation just because their packages may take more time to arrive. 

Under a recent consolidation effort by the U.S. Postal Service, though, rural areas farther away from processing hubs are seeing more reductions in service compared to their urban counterparts, even in areas that haven’t technically seen parts of the plan go into effect yet. 

“The mail, it’s awful. Sometimes we don’t even get things that were sent to us,” said Leah Lawson, vice president of the Bank of New Madrid in southeast Missouri.

The bank and its customers rely heavily on mail delivery to pay their bills. But more and more people are getting slapped with late fees because their payments don’t make it on time.

“It’s their light bill or water bill, and if it gets lost it doesn’t matter,” said Lawson. “You’re getting a late fee, because they say it’s your responsibility.” 

In late July, the Postal Service cut back on services in 540 — nearly half — of Missouri’s ZIP codes by reducing mail collection from morning and evening to morning-only collection. 

It’s part of the Postal Service’s efforts to cut costs under former Postmaster General Louis DeJoy’s “Delivering for America” plan, which launched in 2021. 

During a June Congressional hearing, commercial mailing groups and package shippers pushed for a pause on the plan, citing negative performance impacts and increased costs. 

Missourians have noticed the shift. 

“Some days you don’t get mail,” Lawson said. “It seems like I’ve gone a whole week without getting anything, then get a whole stack of it in one day.” 

How Kansas City and St. Louis power mail for all of Missouri 

The Postal Service handled over 112 billion pieces of mail in 2024, down from 154 billion in 2015. In fiscal year 2024, the Postal Service’s total operating expenses were $89.5 billion, while the agency had a net loss of $9.5 billion. 

The Postal Service said that shifting from a focus on air transportation to primarily moving mail across the country on trucks would save the agency money. Pickup schedules started changing in 2023. Since then, the Postal Service has loosened its requirements for mail delivery times and has struggled to meet even those lower benchmarks.  

Under the plan, post offices no longer have afternoon mail pickup, which collects mail and moves it to a larger plant in Kansas City or St. Louis for processing. The mail is now collected the next day, including priority mail, delaying its entry into processing by a day. 

In April, the Postal Service changed its service standards to account for the change, by changing priority mail from a next-day guarantee to a one-to-three-day guarantee. 

Even still, the agency has had trouble meeting those standards, said Christopher Shaw, a historian and author on the Postal Service. 

“They’re changing the goalposts, but they’re also having trouble meeting the new standards they’ve set,” Shaw said. “There just hasn’t been a track record of success in terms of the results for the American public … or the claimed cost savings to the agency.” 

In a statement, the Postal Service said the agency does not expect rural customers in Missouri and Kansas to see service downgrades 

“These service standard refinements do not depend on whether an area is urban or rural, but rather a collection point’s distance from an origin (regional processing and distribution center),” regional spokeswoman Tara Jarrett said in an email.  

“The changes add one day to the delivery expectation for mail and packages sent from certain ZIP Codes, but they also include improvements to the processing and transportation of mail and packages within our network. For some mail and packages, the changes will shorten expected delivery times by a full day,” she said. 

Assessments of the plan by the Postal Regulatory Commission, a federal agency that oversees the Postal Service, found that the agency used flawed methods to justify the service changes. 

“The Commission finds that the Postal Service’s proposal relies on defective modeling, overly optimistic financial and cost saving projects, and unclear timeframes for the rollout of the changes,” the group wrote in an advisory opinion in January. 

“In addition, the Commission finds that the proposal fails to fully consider the significant, negative impact of these changes on rural communities across the country,” the group wrote. 

The mail system is interdependent, and flaws at one point of processing lead to flaws until the mail shows up at your doorstep, the commission wrote. 

Even before evening mail collection ended, persistent challenges at the Kansas City and St. Louis processing centers — which process mail for the region, including parts of Kansas and Illinois — had residents questioning the reliability of the Postal Service. 

At the request of the region’s elected officials, including Republican Sens. Josh Hawley of Missouri and Roger Marshall of Kansas and Republican Rep. Ann Wagner of Missouri, the Office of the Inspector General performed audits of the Kansas City and St. Louis processing and distribution centers in recent years. 

The audits found persistent staffing issues and inefficiencies. For example, in St. Louis the processing plant failed to use automation to process all of the mail it could, leaving millions of pieces of mail to be sorted manually by local post offices. 

The recent audit found that in St. Louis processing went past the time target on 39 out of 75 days from February to April. In June, the auditors identified 2.2 million delayed letters, 355,259 delayed flats and more than 1,000 delayed packages. 

Since fiscal year 2022, on-time first class mail deliveries have dropped 4.5% nationwide, an OIG report found. 

In Missouri and Kansas, first class mail met performance standards 74% of the time in fiscal year 2025, compared to 88% three years prior, and takes an average of three days to deliver. In September alone, mail met the performance standard 86% of the time.  

“There are some areas closer to the new transportation hubs where they’re saying delivery time has improved a little bit,” Shaw said. “Then there’s other areas where they explicitly admitted that the time of delivery wouldn’t improve. And that’s kind of the purpose — to degrade the delivery standards so that way they can run less trucks.”  

Is there an argument for reducing Postal Service operations?

The Postal Service points to a decline in single-piece mail, such as bills, letters or other communications, as a reason to reduce services. The agency has stated that volume has dropped by 80% since the 1990s.

But Shaw said reducing those services harms those who still rely on the mail the most. 

“The impact is greatest for the average citizen, for the person who is mailing a single letter,” Shaw said. 

While some communities may be able to transition to paying their bills online or using a different shipping service for their business, there are still millions who rely on what the Postal Service provides. 

“We have a lot of elderly customers who are not tech savvy and who flat out refuse to pay online or use a computer,” Lawson said. “For some people, the funds are not there enough to begin with for them to survive, let alone deal with these kinds of issues. You should still be able to count on it.” 

That’s exactly the argument Shaw makes against scaling back the services. 

“It’s not a company that exists to make a profit,” Shaw said. “It’s set up as a service, not a business. That’s the idea, and it’s because a for-profit business does not want to deliver to those rural areas.” 

The Postal Service often steps into the delivery process when it becomes too costly for other companies to complete the delivery, mostly in rural areas, Shaw added. 

Still, Missourians rely on the Postal Service for essential documents and medications.

A KFF analysis found that in 2018, nearly 14 million Americans enrolled in Medicare Part D or large employer plans used mail-order pharmacies for at least one prescription. 

The Department of Veterans Affairs also fills a majority of its prescriptions through the mail. A 2016 study found that prescriptions filled through the mail contributed to better medication adherence for those with chronic conditions. 

For rural Missouri businesses and farmers, poor mail delivery can put their operations at risk. 

Katie Nixon, a farmer and vice president of the Missouri Farmers Union, hasn’t noticed much of a change in her service since the plan went into effect in July. But she and her members have noticed the deterioration of service over the past handful of years. 

Live plants have arrived at farmers’ doorsteps dried out, and poultry farmers have dealt with birds that died during delayed shipping processes.

Aside from the impact it has on business operations, Nixon worries it will only push potential customers of these small businesses to other, more convenient options. 

“If an urban person is waiting two weeks for their product, they’re going to say, ‘I don’t know if I’ll get it from there next time, because Amazon can just get it to me the next day,’” she said. 

She worries about the precedent it sets for serving rural communities in the future. 

“It’s hard to say whether or not these small changes are going to affect me day to day,” she said. “But once those smaller changes start getting into bigger changes … that’s really going to be a problem.” 

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For Dr. Kelsey Davis-Humes, practicing medicine in rural Missouri is a way of life. She’s on call almost constantly in northeast Missouri’s Scotland County, where she cares for patients from their birth until their death. 

As an osteopath practicing in a rural community, part of her job includes caring for patients throughout their pregnancies. 

“I do inpatient hospital coverage,” Davis-Humes said. “I deliver babies and do women’s health. I do pediatric care, newborn care. I am in the clinic. I go to the nursing home.” 

While her area hasn’t lost an obstetrics unit in recent years, Davis-Humes has seen the impact on the state as a whole as pregnancy care becomes more difficult to access. 

Missouri has lost 11 obstetric units since 2009, with seven of those in rural parts of the state, a report from the University of Minnesota Rural Health Research Center found. The closure of hospital obstetric units means women have to travel farther for their appointments and their deliveries. 

As the units have closed, more parts of the state have fallen into maternity care deserts — areas without access to birth units or maternity care providers.

Based on 2023 data, Missouri is marked by more maternity care deserts than the nation as a whole. March of Dimes data shows that 41.7% of Missouri’s counties are classified as maternity care deserts, compared to 32.6% nationwide. 

Part of the problem for rural providers? Medicaid payments. The government-sponsored health insurance plans do not reimburse obstetric care fully, meaning for every baby they deliver, the hospital takes a loss. 

“Every hospital who does birth services loses money,” said Alison Williams, vice president of clinical quality improvement at the Missouri Hospital Association. Williams also leads Missouri’s Perinatal Quality Collaborative, a statewide task force dedicated to improving outcomes for moms and babies across the state. 

In Missouri, about 40% of the state’s births were covered by Medicaid in 2023, KFF data shows. 

As Medicaid cuts under President Donald Trump’s budget plan begin to materialize, anywhere from 130,000 to 170,000 Missourians are expected to lose their coverage over the next five years. The budget also changes how states can pay for Medicaid patients — and how much.

“We are going to be paid less,” said Craig Thompson, the CEO of Golden Valley Memorial Hospital in Clinton. 

That could put rural hospitals with obstetric units at higher risk when it comes to continuing to offer their services, and will require more creative thinking from Missouri and its health care providers.  

Rural Missouri’s maternity care shortage 

Missouri’s health care challenges are compounded when it comes to maternity care. As health care services become more difficult to access, chronic conditions rise and lead to more complicated pregnancies. 

Then, obstetric providers and care teams must be prepared to take on more high-risk pregnancies. 

In Missouri, 68.7% of counties have a high burden of chronic health conditions and a high rate of preterm births, March of Dimes data shows, higher than the nationwide average. An estimated 45.5% of women living in Missouri had one or more chronic health conditions, compared to 37.8% nationwide. 

“In general, you see more high-risk patients,” Davis-Humes said. “People are sicker, they’re more unhealthy, so we just see more patients that have more of these high risk conditions during their pregnancy.” 

An added layer is the growing distance that rural women in Missouri must travel to get their care. Women living in maternity deserts — just over 40% of the counties in Missouri — have to travel 3.6 times farther than women living in areas with full access to maternity care. 

That means things like prenatal care and regular checkups are even farther out of reach, and missing appointments raises the risk during pregnancy even more. 

That’s showing up in Clinton and impacting how Thompson and his team think about maternity care. At their hospital, 63% of about 350 deliveries that happen every year are considered high-risk.

“Many Medicaid patients don’t have access to transportation, either they cannot afford transportation or there is no public transportation in rural Missouri,” Thompson said. “So without transportation access, people don’t have the ability to access that prenatal care, which then causes poor birth outcomes.” 

And with high-risk pregnancies, soon-to-be moms in rural areas are drawn to more robust hospital systems with more speciality providers.

The downside to that, Williams said, is people who have the ability to travel to a larger hospital often take their commercial insurance with them, driving up the rate of deliveries that are covered by Medicaid for their nearby hospital and making it even harder to continue providing labor and delivery services. 

“It creates an even larger, disproportionate share of Medicaid and vulnerable patients, or patients who don’t end up engaging in prenatal services,” Williams said. 

As a hospital leader, Thompson and his team are committed to continuing to provide obstetric services in their hospital. But because so many of their births are covered by Medicaid and cost more than what they are paid, they rely on other services to cover that loss. 

“If we were to look at those services on their own, they would be a significant financial drain to the system,” Thompson said. “We are kind of robbing Peter to pay Paul, to some extent.”

Plus, obstetricians and gynecologists, like most other medical providers, are looking for work-life balance, such as splitting their patient loads with multiple providers and other upsides that often come with working in a more populated area. 

It can be difficult for rural providers to balance all of those needs, especially since monitoring labor and deliveries are so sporadic. 

“If you have enough providers, you will likely have enough (patient) volume,” Williams said of rural providers looking to keep their birth units open. “The challenge is making sure you can maintain enough providers to where they have that work-life balance.” 

What do health leaders want to see for OB-GYN providers moving forward? 

As providers look to fill the gaps in maternal care, they’re leaning on innovative ways to ensure that every Missouri mother has access to adequate care. 

For example, providers in Harrison County, which sits in northwest Missouri along the Iowa border, created a partnership with North Kansas City Hospital for labor and deliveries. Expecting mothers get prenatal care in the county, but travel to Kansas City for their deliveries. Afterward, patients are handed back to their providers in Harrison County. 

Those types of partnerships are key to ensuring that mothers are followed every step of the way throughout their pregnancies, Williams said. Creating similar partnerships is one of the state’s goals moving forward. 

“It’s important to have that good flow of prenatal records,” Williams said. “It’s important to have that connectivity, that handoff for the patient, so the patient feels like people know what’s going on with their care.” 

The state is also focusing on recruitment and retention as part of the path to solving the problem. Davis-Humes mentors many aspiring doctors, who say that the workload of being on call constantly in rural communities is a deterrent for them. 

“You’ve got to have people that are willing to come to an area and wear multiple hats, and also be willing to be called in in the middle of the night, too,” she said. 

But she also wants to see more unique ways of encouraging rural providers to continue providing a service that makes them lose money. 

“I think the state needs to put their money where their mouth is,” Davis-Humes said.

“We keep seeing all these birth centers close. We keep seeing that OB has a hard time making money … I think there should be some type of reward there,” she said. “You keep your OB center open, every year you get some sort of incentive from the state that says ‘Thank you … we’re going to help support you so you can continue to keep that OB unit open.’” 

Although hospital executives are expecting to reassess their finances and the services they provide in the coming years as a result of Medicaid cuts, they are encouraged that they are seeing a new willingness to discuss the financial difficulties rural providers face. 

“At some point, there has got to be real reform around reimbursement for rural health care services,” Thompson said. “We’re just not the same as our urban and suburban counterparts.” 

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Unyielding is a University of Missouri School of Journalism project for Investigate Midwest.

KENNETT, MO. — Nestled in Missouri’s Bootheel is the small town of Kennett, the Dunklin County seat. With just over 10,000 residents, it’s a close-knit community where good-natured teasing is a common show of affection.

Once a sprawling swampland, it has since been transformed into an expanse of flat, fertile fields where agriculture stands as the backbone of the region’s economy.

Kennett’s houses don’t get much taller than one story, and as visitors stroll down the main street, they’re welcomed by a mix of restaurants, boutiques and a cozy hair salon. These buildings are dwarfed in size by a silent, boarded-up hospital, its vacancy a remembrance of what the community has lost.

It’s the kind of community where if something tragic happens, everyone finds out. 

Bobbi Bibbs found this out the hard way. She discovered she had cancer in her colon in December 2023, which then metastasized to her liver, making it a stage four diagnosis. 

Bibbs isn’t alone. Dunklin County is among the 10 counties with the highest rates of that type of cancer in the state. This isn’t just a statistic, Bibbs said she can see it and almost can’t fathom it. 

“There are so many (cases) where we are from,” Bibbs said. “Like, it’s got to be coming from somewhere.”

Bibbs is surrounded by people who understand her struggles, many of whom work in the agriculture industry. In Dunklin County, there are hundreds of thousands of acres of crops — and most of that land is blanketed by pesticides. 

Estimates suggest that thousands of kilograms of pesticides are sprayed over Missouri cropland each year. In some places, wastewater sludge containing “forever chemicals” — per- and polyfluoroalkyl substances — is applied on farmland as fertilizer.

Multiple scientific studies have explored a connection between pesticide use and cancer,  pointing to a silent public health crisis hitting rural communities particularly hard.

The University of Missouri, in partnership with Investigate Midwest, conducted a county-by-county analysis of cancer rates and pesticide use, using the most recently available data for pesticides that are repeatedly cited in research as likely to be associated with cancer risk.

The six counties with the highest use of these pesticides per square mile are all located in the Bootheel, including Dunklin. Four of those counties are in the top 15 for overall cancer rates in Missouri. All counties with the highest rates of cancer are rural.

So in Kennett, there are high rates of chemical usage, high rates of cancer — and the nearest trauma center in the state is more than an hour and a half away.

In other words, it’s a typical rural town in Missouri. 

Green hills and kilograms of chemicals

While Missouri has its share of rolling hills covered in trees and wild foliage, much of the land is well developed to suit the needs of farmers and their crops. There are about 27 million acres of Missouri farmland being cultivated and nearly 88,000 farms, according to the Rural Farm & Finance Policy Analysis Center. 

The biggest business in the state is agriculture, employing about 460,000 statewide, according to the Missouri Department of Agriculture. Soybeans, corn and wheat are some of the crops that color most of the state’s landscape. 

Farming is a dangerous job that requires a good deal of heavy equipment and specialized tools. Those tools include chemicals.

Isain Zapata is a data scientist who researched the relationship between pesticides and the incidence of cancer. He looked at the complex mixtures of pesticides tailored to specific crops that are sprayed in different regions. 

“When we look at those pesticides, it’s not just one — it’s all a cocktail,” Zapata said. “It’s the whole rainbow of different colors.” 

He found that these colorful combinations are strongly linked to certain cancer rates across the nation.

“Non-Hodgkin’s lymphoma and leukemias are very intimately associated with pesticide use,” Zapata said. “But we also saw that the overall pesticide use has an effect on all the other non-obvious cancers.”

Other research shows an association between certain pesticides and an increased risk of brain, prostate, breast, kidney and colon cancers.

Pesticides are a classification of substances used to protect crops. This includes killing weeds, insects or even strengthening wood to prevent pests from harming the plant. Farmers typically apply pesticides to crops using methods such as aerial spraying or ground-based equipment.

Serious risks are posed by pesticides because they can harm both human health and the environment. Exposure may lead to short-term or long-term health problems, while also contaminating soil and water, which may disrupt ecosystems and affect wildlife.

But pesticides do what they do best. Zapata emphasizes that without pesticides, agriculture-based economies and the communities tied to them would suffer.

“I am not in favor or against pesticides,” Zapata said. “I know we need them. I don’t like them, but I know why they have to be there.”

He said rural agricultural areas are home to an intense combination of factors that multiply the risk level.

Farmers are under pressure to maintain or increase their productivity, and that comes at the cost of using compounds that carry health risks, Zapata said. Rural areas are often underserved by health care facilities, meaning there are often too few health providers and resources in theose areas to monitor and manage the added risk of using pesticides.

“It’s just the perfect storm,” Zapata said. “You combine several factors (heavy pesticide usage, poor regulation and monitoring, socioeconomic disparities), you’ve made it worse.”

The million-acre highway

Mike Milam is a local expert in pesticide application. Based in Kennett, he is a field specialist in agriculture and environment for MU Extension, serving Dunklin, New Madrid and Pemiscot counties. 

“I’ve had people tell me, especially the ones who don’t like chemicals at all (that) our bodies weren’t designed to breathe these chemicals,” Milam said. “And they’re right about that.”

The herbicide Roundup is the target of thousands of lawsuits claiming it causes cancer, putting it in the spotlight. Milam listed other chemicals that have caused concern, including paraquat, vydate and dicamba.

Farmers and the workers hired to harvest crops frequently interact with chemicals. From mixing to pouring to spraying, they are there for all of it. They also encounter other farmers’ chemicals when a substance sprayed in one area drifts somewhere it was not intended to be. 

“I have known a situation (where) people out in the fields got sprayed, or they sprayed next to them, and then it drifted over. And things like that,” Milam said. “Matter of fact, when I was in graduate school, I was in a field down in Louisiana, and they were spraying right next to us. We actually had to leave the field.”

Direct drift occurs when an applicator applies a pesticide and the wind blows it elsewhere, making monitoring weather conditions an integral part of the process. The stronger the wind, the stronger the potential is for drift. 

That said, farmers have a limited window to seed and fertilize their fields during planting season. Fluctuating weather conditions can make this even more difficult. This spring alone, the Bootheel faced tornadoes, dust storms and historic flooding, all of which have the potential to hinder field work.

“We go out here, we can plant a crop, it looks beautiful, a flood wipes it out, and we gotta start back over,” said Sen. Jason Bean, R-Holcomb, a fifth-generation Bootheel farmer.

Milam said that some farmers end up spraying their crops when conditions aren’t ideal.

“The farmers aren’t paying attention or just decide to go ahead and (apply) anyway because they need to get it done,” Milam said. “They are under a lot of stress, they’re trying to get the crops in.”

Jason Mayer, a fourth-generation Bootheel farmer and one of the directors for the Missouri Soybean Association, believes that, nine times out of 10, farmers are doing the right thing. In his mind, it is the “bad actors” going against best practices. Bean compares this to speeding on the highway.

In his analogy, like drivers on the road minding the speed limit, most farmers follow the rules. Just as there will always be that driver blowing past everyone else in the left lane, there will be farmers who break the rules. 

Agricultural regulators — such as the Missouri Department of Agriculture or EPA — serve as the cop on the side of the road in the metaphor. They step in when misuse is suspected. Environmental Protection Agency inspectors can show up at any time and ask to see a farmer’s records, Milam said. 

With millions of acres of farmland in Missouri, that’s one big highway to watch. So if agencies don’t catch someone breaking the rules, it can fall to local farmers to report their neighbors to the state pesticide control office.

Bean emphasized that proper pesticide application isn’t just about compliance, it’s also in the farmer’s best interest. Misuse wastes costly chemicals, reduces crop effectiveness and decreases consumer trust in locally grown produce. 

“I’d say we’re great stewards of the land,” Bean said. “We’re going to continue that, because in the big picture, farmers want to produce for the world the safest, abundant product.”

Milam said the key is to use the chemicals appropriately to minimize exposure. He said wearing personal protective equipment during application is a best practice. So doing things like wearing long pants, long-sleeved shirts, masks and goggles is essential for safe use. 

Bean does not believe pesticides cause or increase the risk of cancer. Mayer echoes this sentiment, emphasizing his lifelong experience around crops and chemical applications.

“I’m 42 — knock on wood — today,” Mayer said. “I’m still relatively young, perfectly healthy, and I’ve been on the farm since I was 14.”

Waiting on a waiting room

Striking up a conversation about health care in Kennett is bound to lead to one topic: the hospital. 

Kennett doesn’t have one anymore; Twin Rivers Regional Medical Center closed its doors in 2018. 

For quick stitch-ups or infection treatment, St. Bernards Urgent Care is open every day. It closes at 7:30 p.m., meaning that Kennett residents have to go elsewhere for their nighttime care. 

There are various options in nearby counties, or even in neighboring states, but if someone needs emergency care, for example, it’s a trek. 

While there’s a Mercy Hospital located in nearby Dexter with a rotation of specialty doctors, the closest Missouri trauma center to Kennett is in Cape Girardeau, about an hour and a half away. 

“(If) I have a heart attack at eight o’clock at night, or stroke, and if (the urgent care) was still open, they could give me that little fancy pill and help get me to the hospital to help,” said Cheryl Bruce, the executive director of the Dunklin/Stoddard Caring Council, an organization based in Kennett offering an assistive services program to Dunklin County residents with cancer.

Kennett’s old hospital building is still standing on the town’s main drag. The windows are boarded up, and walking through the halls requires ducking wires and tiptoeing over glass shards.

The current owner is in a zoning battle to turn the hospital into something. They haven’t been able to find buyers yet because they need various approvals from the city to do any work to make the building sellable. 

Kennett isn’t alone in facing minimal health care access. Since 2014, 21 hospitals have shut down statewide, including 12 in rural areas, according to the Missouri Hospital Association. 

Additionally, the Center for Healthcare Quality and Payment Reform’s 2023-2024 report found 26 rural hospitals in Missouri are at risk of closure due to financial strain — nine of them are at an “immediate risk.” 

The Twin Rivers CEO said in a 2018 statement that the hospital’s closure was part of an effort to consolidate operations with Poplar Bluff Regional Medical Center, “as health care delivery evolves and medical innovation makes inpatient services less needed,.”  KFVS12 TV reported at the time.

It was a palpable loss for Kennett — people miss the hospital, Bruce said.

“When the hospital closed, all anybody has ever talked about is, ‘Are we going to get another one?’ ” Bruce said.

From 2020 to 2024, the Caring Council’s cancer assistive services program spent $22,650 helping over 400 people with transportation. For cancer care, folks in Kennett often travel an hour to Jonesboro, Arkansas, or an hour-and-a-half to Cape Girardeau in Missouri. Whatever kind of cancer care you need,, Bruce said, you’ve got to drive to get it.

The lack of health care providers also means early detection of medical issues, including cancer, can be harder to get.

Some health care transportation programs are available in rural areas, but Bruce said she sees a need in her community for more robust services. 

“I’m not asking for a bus system like in St. Louis or Kansas City or Jeff City,” Bruce said. “I’m just asking for access to care, whatever that means.”

Sprayed on all sides

Wherever you go in Kennett, there will be someone who’s called it home their whole life. Kennett’s City Clerk Jan McElwrath is one of those people. Aside from a brief stint at the University of Missouri, she’s spent nearly all of her 68 years in town. 

She came back for a classic reason: love. She got married, raised a family and built a life rooted in the same streets where she grew up. 

Over the decades, she’s seen businesses open and close, celebrated countless community milestones and weathered natural disasters. Through it all, McElwrath has observed one constant: despite differing beliefs and opinions, the people of Kennett always find a way to come together.

“Our strength is our people, hands down,” she said.

This is especially important when considering the unique challenges of rural living. 

An index created by the CDC shows that Dunklin is the county in Missouri least prepared to deal with economic or environmental challenges. According to Feeding America, over 20% of Dunklin County is food insecure, despite the fact that the region is covered in farmland. Milam said that this is largely because the farms in Dunklin are agronomic, which is when crops aren’t always grown for direct human consumption. 

“It would help a lot of people if they had fresh vegetables,” he explained.

As manufacturing jobs moved out of many places in the Bootheel, Kennett felt the economic sting. Though Cim-Tek Filtration’s arrival two years ago brought back some manufacturing jobs, Kennett lost its Emerson Motor Company plant in 2006.

One industry that remains is agriculture. 

The land is dotted with cotton, soybean and rice row crop operations. McElwrath calls the rows of cotton ready for picking “southern snow,” but to get that snow, farmers usually have to give plants a nudge with defoliants. 

Defoliation is a natural process, though it can be artificially induced when chemicals are applied to the plants to get them to open up, making the white cotton easier to harvest. 

McElwrath said it’s hard to notice farmers defoliating at first. But then, suddenly, your sinuses sting, your eyes burn, maybe a headache creeps in. It always seems to hit around the same time every year, right when the county fair is going on — with the dust, the dry soil, the demolition derby — everything blending together. 

It’s not just that the defoliants make things happen quicker; they help make the cotton a higher grade — that means there is less debris affecting the final product. The grade determines the value. 

Many residents of Kennett recognize the need for defoliants and other agricultural chemicals. For some of them, that’s what puts food on the table. But then the time of year creeps around again, and they all experience that familiar sensation. 

“We’re surrounded by agriculture,” McElwrath said. “We recognize (chemicals) as a risk, but our economy here is very dependent on agriculture.”

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Read the rest of the series.

Unyielding was produced by students at the University of Missouri School of Journalism. The team included researchers, reporters, data analysts, photographers and graphic designers. The students, most of whom were seniors who graduated in May 2025, included:

Reporters: Mary McCue Bell, Alex Cox, Jonah Foster, Prajukta Ghosh, Adeleine Halsey, Ben Koelkebeck, Xander Lundblad, Lillian Metzmeier, Kyla Pehr, Seth Schwartzberg, Savvy Sleever and Mayci Wilderman.

Data and graphics: Alex Cox, Yasha Mikolajczak and Mariia Novoselia

Photography: Michael Baniewicz

For questions about the project, please contact Mark Horvit, horvitm@missouri.edu.

The post The unseen harvest: Pesticides, cancer and rural Missouri’s health crisis appeared first on Investigate Midwest.

Missouri’s 67 rural hospitals are pondering a dramatically different future under President Donald Trump’s new budget plan.

The recently approved budget bill will slash federal Medicaid spending by more than $1 trillion over the next decade. By some estimates, it could lead to 8.6 million people nationwide losing health coverage. 

Various estimates conclude that between 130,000 and 170,000 Missourians could lose coverage under the state’s Medicaid program, known as MO HealthNet, over the next decade. 

And even if you have commercial insurance, the impact on hospital operations and finances could still affect your health care. As people delay treatment for their health conditions due to a lack of insurance, they’ll start relying more on the emergency room as their primary form of health care, experts say. 

That will lead to more crowded emergency departments. Moreover, the burden to pay for uninsured patients will shift onto the hospitals that provide the care, and eventually back to patients. 

With the budget plan in motion and spending cuts materializing, Missouri’s hospitals are now taking a look at their finances and preparing for an uptick in costs. 

For rural Missourians, even those who aren’t on Medicaid, it means the types of health care available to them in the form of obstetric units, primary care providers or specialty providers could be changing. 

Or their nearby hospital could be gone altogether.

“We are likely going to see rural hospital closures,” said Sheldon Weisgrau, the vice president of health policy at the Missouri Foundation for Health, in a press briefing. 

“We have not had any rural hospitals close since we expanded the Medicaid program,” he said. “We are likely to see rural hospitals close because they operate on the financial edge.” 

What do worsening hospital finances under Medicaid cuts mean for you? 

Mercy, which is based in the St. Louis area, operates 112 hospitals and emergency rooms across Missouri, Kansas, Oklahoma and Arkansas and has a large footprint in rural Missouri. Mercy estimates that the budget will lead to bigger revenue losses every year. 

Five years from now, they estimate, they’ll lose $300 million in revenue annually. 

“That’s going to mean we’re going to have to radically look at how we deliver care differently — that is still responsive to our communities,” said Cheryl Matejka, the executive vice president and chief financial officer at Mercy. “It’s going to be different for us to survive and thrive.” 

Under the plan, Missouri stands to lose an estimated $23 billion in federal funding over the next decade, according to the Missouri Foundation for Health.* Much of Missouri’s federal money covers the cost of Medicaid for the Affordable Care Act expansion group, which voters approved coverage for with an amendment to the state constitution in 2020. 

The new federal budget restricts how states and hospitals can pay for the services they provide by limiting the fees that states can collect from health care providers. It also puts limits on what states can pay hospitals to help them fill gaps in their finances for treating Medicaid patients. 

Broken down by year, Missouri’s federal funding for Medicaid will drop about 20% annually as the plan moves forward, Weisgrau said. 

“All of this is going to have a disproportionate impact in rural communities,” Weisgrau said.  

The Missouri Foundation for Health analyzed the budget plan, he added, and found that rural health care providers could lose 21 cents of every dollar they currently get from Medicaid. 

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According to KFF, hospitals overall had an operating margin of 5.2% in 2023. For rural hospitals, that margin was 3.1%.  

The bulk of the concern stems from an expected rise in uncompensated care — hospitals treating patients even if they cannot pay. 

“When folks lose their insurance coverage, it doesn’t mean they don’t continue to get sick,” Weisgrau said. “A lot of them stay out of the health care system because they know they can’t afford it.” 

Once their health deteriorates to a certain point, they go to the emergency room, where they are required to be treated, even if they cannot pay for that care. 

Mercy, for example, sets aside part of its budget to account for that cost. 

“We give away about half a billion dollars of uncompensated or unreimbursed care,” said John Mohart, the executive vice president and chief operation officer for Mercy. “Some of that is for Medicaid patients already, because it doesn’t cover the costs that we have.” 

But for smaller hospitals, the flexibility to provide that uncompensated care isn’t there. Fewer insured people will only increase costs. 

“If you see an uninsured patient, then you probably have to assume that there is a pretty good chance you’re just going to have to eat those costs,” said Timothy McBride, a public health expert and economist at the Washington University School of Public Health.  

As a result, even those covered by commercial insurance could see their premiums rise to help cover the care. 

“These costs are passed on to the rest of us,” Weisgrau said. “We will see private insurance premiums going up. Even folks who have good coverage from their employers and think they might be immune from some of these Medicaid cuts  will see impacts of this down the line.” 

How far will the rural hospital fund go in saving at-risk hospitals? 

To help offset some of the costs rural hospitals are taking on, senators in Washington lobbied for the inclusion of a rural hospital stabilization fund. The budget included $50 billion for rural hospitals over the next five years with the possibility of renewing the fund in the future. 

Half of it will be distributed by the Centers for Medicare and Medicaid Services, while the other half will flow to states to then send to hospitals. 

But the fund won’t be enough to offset the losses rural hospitals are anticipating.

Medicaid spending in rural parts of the country is expected to fall by $137 billion over the next decade — $87 billion more than was allocated to the rural hospital fund, according to KFF. 

And even those estimates, KFF said, are modest because they don’t account for how states may change the way they fund Medicaid. 

During negotiations surrounding the budget bill, senators asked the University of North Carolina Cecil G. Sheps Center for Health Services Research to analyze how many rural hospitals may be at risk under the plan. 

Their report found that nearly 340 rural hospitals were at risk nationwide, based on the rate of Medicaid patients they serve and their consecutive years of financial losses. 

In Missouri, four hospitals were considered at-risk, while in Kansas, six hospitals were listed. 

One of those hospitals is Bothwell Regional Health Center in Sedalia, the city’s largest employer with more than 1,000 employees. 

In 2024, the hospital posted its first profit since 2018, Bothwell CEO Lori Wightman said in a press release in July. Notably, Medicare and Medicaid provided 78% of the payments for its patients. 

“These programs pay well below the actual cost of providing care,” Wightman said in the release. “Commercial insurance alone cannot close the gap, and that is where subsidies available to rural hospitals are essential. Unfortunately, the cost of providing care, from personnel to technology, continues to rise making a difficult situation harder to stabilize.”

Other Missouri hospitals included on the list were Scotland County Memorial Hospital in Memphis, Parkland Health Center in Bonne Terre and Lafayette Regional Health Center in Lexington — Sen. Josh Hawley’s hometown. 

Studies show that after a rural hospital closure, low-income and elderly patients were more likely to defer or skip their health care altogether because of transportation challenges. 

Rural hospital closures also lead to a loss of physicians. One study found that the closure of a rural hospital led to an 8.3% drop in primary care physicians and a 4.8% drop in obstetricians and gynecologists. 

“Health care providers are big employers,” Weisgrau said. “They are big users of local supplies and commodities. All of that will have to be reduced. People will lose jobs. Economies will decline as a result of these cuts.” 

* Meg Cunningham’s coverage of rural health is funded by the Missouri Foundation for Health. 

The post Rural hospitals in Missouri already struggle to turn a profit. Medicaid cuts could force some to close appeared first on The Beacon.

The Trump administration has repeatedly denied disaster mitigation funding to states hit by extreme weather events, another step in President Donald Trump’s plan to downsize and phase out the Federal Emergency Management Agency, and lawmakers aren’t sure why it keeps happening.

Since March, states including Oklahoma, Missouri, Iowa and Mississippi suffered severe storms, winds or wildfires and requested assistance through the Hazard Mitigation Grant Program at FEMA, which provides funds to help protect against future natural disasters. Unlike the Biden administration, Trump is no longer automatically approving those grants and has denied seven requests this spring, according to Bloomberg, while six requests remain under review.

Oklahoma made one such funding request after March wildfires and winds ravaged the state, killing several people and damaging hundreds of homes, according to the Oklahoma Department of Emergency Management. Those fires burned Gov. Kevin Stitt’s farmhouse to the ground.

FEMA approved several Fire Management Assistance Grants in Oklahoma, which help state, local and tribal governments cover fire-related damage costs, but it denied a request for mitigation funding in early June.

“Well, I’m usually on the side of my state, so we’ll wait and see what happens,” Rep. Tom Cole of Oklahoma said of the funding denial.

Oklahoma Sen. James Lankford said he’d have to see the requests in order to answer questions about the resilience funds. But while disaster aid is often necessary, it’s not simple, he said.

“There’s not a time, obviously, when there’s a disaster — maybe it would be a flood, a wildfire or our famous tornadoes — that we don’t need help from someone,” Lankford said. “But there’s a mixture of private insurance, state funding and federal funding, a formula set up on the federal side, to try to figure out when that actually kicks in. We’ve got to be able to make sure we actually meet that.”

At the beginning of June, the administration denied two requests from Missouri after tornadoes and storms in March and April killed residents and tore up communities.

Sen. Josh Hawley said he had talked to Trump about FEMA grants for Missouri in the past, which he was grateful the president had approved. But Hawley supports his state’s request for mitigation funding that Trump has since denied.

“It’s been a really tough spring in our state for natural disasters. We’ve lost almost 20 people, and all across the state, suffered a lot of damage,” Hawley said.

“We may have to go back and ask for more,” he said of FEMA funding. “We’re not able to do the recovery with what we’ve got.”

Bloomberg reported that Oklahoma received other federal funds it could use in a similar way to the HMGP grants and is not appealing the administration’s decision, but Missouri officials were already putting together an appeal.

In late May, the entire Washington delegation wrote to Trump after he denied aid funding for a November bomb cyclone that hit the state. The letter said the state’s request detailed over $30 million in damages, costs that local governments cannot and should not be expected to shoulder alone, including mitigation funding.

“Washington state’s first responders, local governments, and emergency management professionals have done everything within their means to begin recovery, but the scale of the damage requires federal support through the Public Assistance Program and the Hazard Mitigation Grant Program,” the letter read.

The administration denied the state’s appeal last week, according to The Seattle Times.

The White House said it’s seeing large amounts of funding across the board that haven’t been delegated to any specific project yet, and it wants to decrease that spending.

“The Trump administration is monitoring the approval of HMGP with states’ ability to execute those funds,” White House spokesperson Abigail Jackson said in a statement. “We are working with states to assist them in identifying projects and drawing down balances in a way that makes the nation more resilient.”

The post Lawmakers Don’t Know Why Trump Keeps Denying Disaster Mitigation Grants appeared first on Oklahoma Watch.

After years of exponential growth, opioid overdose deaths in Missouri are dropping. 

While health care workers, community groups and other officials say many factors may contribute to the drop in opioid overdose deaths, they agree that access to overdose-reversing drugs like naloxone, often provided under the brand name Narcan, is saving lives. 

“I do think that Narcan is the reason for those trends statistically dropping,” said Cooper County Ambulance Chief Brandon Hicks. “I see Narcan in a lot more homes than I used to, and I do see family members administering Narcan prior to us getting there.” 

In 2014, the state saw 360 opioid overdose deaths from drugs other than heroin. By 2021, that figure rose to 1,493, state data shows.  

After increasing through 2021, the trend started changing. The number of deaths flattened in 2022 and began dropping in 2023. By 2024, non-heroin opioid overdose deaths had fallen to 876. 

Central Missouri and the St. Louis area saw the largest drop in drug overdose deaths, dropping 38% and 35%, respectively. 

But after responding to opioid overdose calls for years, Hicks sees the need for more access to treatment and better coordination between emergency services and long-term care, especially in rural areas. 

That belief is shared across community health organizations. Access to things like peer support specialists and community resources is an essential piece of the puzzle, according to Derek Wilson, who runs harm reduction at the AIDS Project of the Ozarks, which serves 29 counties in southwest Missouri. 

“I think there is a particular bit of challenge when you come up against some of these societal things,” Wilson said. “When you get into a more rural area … there’s a ton of stigma. There’s still a lot of shaming, whether it’s self-shaming or from outside sources.” 

Wilson hopes that a continued focus on naloxone distribution, coupled with community support and more access to medication-assisted long-term treatment, can continue making inroads in rural communities. 

Did Missouri’s naloxone distribution plan lead to the drop in overdose rates? 

In 2016, the Substance Abuse and Mental Health Services Administration began a new grant program for states to receive federal funds for addiction treatment, recovery and harm reduction services. 

The federal money and state settlement dollars from opioid litigation allowed Missouri to increase investment in addiction treatment and overdose prevention. Early funds were mostly used to support treatment efforts. But as the response evolved, the state began investing more heavily in distributing naloxone across the state. 

From 2017 to 2023, the Missouri Institute of Mental Health (MIMH) distributed nearly 430,000 naloxone kits across the state. In 2023 alone, nearly 250,000 kits were given out, including more kits shipped off to local health departments, social services and first responders, according to a report from researchers at MIMH. 

In their report, researchers connect the drop in overdose deaths with the availability of naloxone across the state. But other rural health researchers think more time is needed to truly understand the drop in deaths. 

“It’s encouraging, but I don’t think we know exactly why it’s changed,” said Kelly Price, a rural addiction researcher in Vermont. “It’ll be interesting to see how it plays out over time … It does sometimes seem like it takes a little bit longer to see those effects that you see nationally in some of these more isolated rural communities.” 

MIMH researchers also pointed to the westward movement of fentanyl across the country. Data show that eastern parts of the country see lower levels of fentanyl-related deaths, while they are rising in western parts of the country. 

Hicks sees the need for better data collection for health officials to truly understand the trends, especially in smaller counties where funds for autopsies may not align with death rates. He pointed to the prevalence of opioid-related cardiac events. 

“We just did a community health assessment,” Hicks said. “We identified that there’s really not been any opioid deaths in Cooper County for quite some time. The problem is that they’re getting ruled cardiac arrest.” 

“At the end of the day this is a true statement, their heart stopped,” he added. “When it comes to pulling statistics, nobody sees the opioid deaths that we do have.” 

If someone’s heart stops as a result of an overdose, naloxone won’t revive them without chest compressions. Researchers at the American Heart Association found that of the 360,000 cardiac arrests from 2017 to 2021, 8% were caused by drug overdoses. 

Part of the problem in collecting that data, Hicks said, was funding for autopsies. If the county only budgets for a certain number of autopsies, it can be difficult to determine whether a death was related to drugs in other ways besides an overdose. 

“I have one gentleman that I have (used Narcan on) three times that’s been in cardiac arrest, and after the third time, he literally told me: ‘See, I can do whatever I want. You’re going to be here to save me,’” Hicks said. “We can’t save somebody who is dead, and they can’t save themselves either. But if they get Narcan before we get there, usually they refuse care.” 

But Stephanie Malita, a health educator at the St. Joseph Health Department, says peer support specialists who are active in the area report that the number of overdoses someone experiences isn’t relevant to their recovery outcomes. 

“Peers will say time and time again that some of them overdosed multiple times,” Malita said. “But eventually they got to the point in their lives where they were ready and had a support team around them to make that very scary leap into non-use.” 

Addressing fear of law enforcement when treating overdoses 

Studies show that despite Good Samaritan laws, which offer legal protection for people who are witnessing or experiencing a drug or alcohol overdose, skepticism remains when it comes to calling first responders in the event of an overdose. 

Missouri’s Good Samaritan law provides immunity from things like possession of controlled and synthetic substances or paraphernalia, as long as someone is actively seeking medical assistance. It also requires law enforcement to provide treatment resources. It does not protect against other crimes like distributing a controlled substance or active warrants. 

Hicks regularly runs into that fear when he responds to overdose calls. If 911 is called, the person overdosing often has already gotten a dose of naloxone, and law enforcement almost always arrives at the scene before EMS.

“People don’t want law enforcement, they feel like they’ve done something wrong,” Hicks said. “So we usually encounter somebody who is angry and upset … because they’re scared of getting arrested. They didn’t want to go to jail, they just wanted to live.” 

He and his staff take extra steps to differentiate themselves from law enforcement when responding to overdose calls. They don’t wear button-up shirts or badges to try and make people feel more comfortable. 

“I appreciate law enforcement,” Hicks said. “But I don’t want to be associated with them in these scenarios, because then I can’t help somebody like we’re supposed to help them.” 

How to address the need for long-term care in rural Missouri 

Wilson and the AIDS Project of the Ozarks are working on ways to make naloxone more available across their coverage area. The group places drop boxes with naloxone kits in places like libraries and other public settings, so it is available to the community 24/7. 

To find where to access free naloxone, click here.

It’s an investment that Malita and the health department, which was one of the top county recipients for naloxone kits from the MIMH, are looking at making as they continue naloxone outreach. 

But more attention is needed when it comes to connecting naloxone recipients with longer-term addiction care. Things like distance to a provider, income, transportation and child care are often cited as roadblocks for rural patients seeking care. 

Hicks said he hopes to see more investment in things like transportation to crisis centers. He also pointed to integrating 911 and 988, the national suicide and crisis hotline, as a way to ensure Missourians are getting the care they need. 

“The emergency room is just not the place for a lot of people in these situations,” Hicks said. “More mental health support (is needed), not a physician that tells them to go seek care elsewhere once they’ve fixed a very temporary problem.” 

Price pointed to data that shows starting people on medication-assisted treatment, including buprenorphine or naltrexone, after an overdose and then connecting them with a long-term provider has been shown to be an effective approach. 

Things like expanded access to telehealth, where people can meet with providers in the privacy of their own homes, can also help people in smaller communities seek care in ways that are more fitting for them. 

Wilson said reducing stigma so everyone feels comfortable seeking care is a priority. 

“I do think it is something that is thicker in rural areas, the idea of not wanting to get into it, and: ‘Why don’t those people just go take care of themselves? Why don’t they stop?’” Wilson said. “It’s just not that simple, not with the way that substances interfere with our brain chemistry.” 

“It’s just a human being and things get away from them,” Wilson said. “Then they find themselves in very, very horrible situations.” 

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A major storm took hold across swaths of the central and southern United States on Wednesday unleashing extreme flooding and huge tornadoes from Arkansas up to Michigan. And conditions are expected to worsen on Friday as soils become saturated and water piles up: The National Weather Service is warning of a “life-threatening, catastrophic, and potentially historic flash flood event,” along with a risk of very large hail and more twisters. Eight people are so far confirmed dead, while 33 million are under flood watches across 11 states.

While scientists will need to do proper research to suss out exactly how much climate change is contributing to these storms, what’s known as an attribution study, they can say generally how planetary warming might worsen an event like this. It’s not necessarily that climate change created this storm — it could have happened independent of all the extra carbon that humanity has pumped into the atmosphere — but there are some clear trends making rainfall worse.

“In a world without the burning of fossil fuels, this event would happen once in a lifetime — that’s kind of what the National Weather Service is saying,” said Marc Alessi, a climate science fellow at the Massachusetts-based Union of Concerned Scientists. “But with the burning of fossil fuels, with more heat-trapping emissions, with a warming planet, this event will become more frequent.”

Rainfall is changing because Earth sweats. When the sun evaporates water off Earth’s surface, that moisture rises into the atmosphere, condenses, and falls as rain. But greenhouse gases trap heat up there, so the planet sweats more in response. In other words, it strikes an energy balance.

A warmer atmosphere also gets “thirstier”: For every 1 degree Celsius of warming, the air can hold 6 to 7 percent more water. That means more moisture is available to fall as rain: This weekend, the slow-moving storm is forecasted to dump as much as 15 inches of rainfall in some areas. “The sponge, which is the atmosphere in this case, will become bigger, which allows the sponge to hold more water and carry it from oceans farther inland,” Alessi said. “That could be tied into this event here.” 

The body of water in question here is the Gulf of Mexico. An outbreak of tornadoes and heavy rain is typical for this time of year as warming waters send moisture into the southern and central United States. And at the moment, the Gulf of Mexico is exceptionally warm. “There’s a lot more fuel for these rain-producing storms to lead to more flooding,” Alessi said. (The influence of climate change on tornadoes in the U.S., though, isn’t as clear.)

So a warmer Gulf of Mexico is not only producing more moisture, but the atmosphere is also able to soak up more of that moisture than it could before human-caused climate change. Indeed, the U.S. government’s own climate assessments warn that precipitation is already getting more extreme across the country, as are the economic damages from the resulting flooding. That’s projected to get worse with every bit of additional warming.

The problem is that American cities aren’t built to withstand this new atmospheric reality. Urban planners designed them for a different climate of yesteryear, with gutters and sewers that whisk away rainwater as quickly as possible to prevent flooding. With ever more extreme rainfall, that infrastructure can’t keep up, so water builds up and floods. And with storms that last for days, like those tearing through Arkansas and Kentucky right now, soils get saturated until they can hold no more water, exacerbating flooding even more. On Thursday, rescue crews in Nashville, Tennessee were scrambling to save people trapped by surging water levels. 

Now scientists will have to pick through the data to figure out, for instance, how much additional rain the storm dropped because of the sponge effect and warming of the Gulf of Mexico. But the overall trend is abundantly clear: As the planet warms, it doesn’t always get drier, but wetter, too.

This story was originally published by Grist with the headline Did climate change supercharge the ‘once-in-a-lifetime’ storm pummeling the central US? on Apr 4, 2025.

Republicans in Washington, D.C., are searching for ways to reduce federal spending to offset the cost of implementing parts of President Donald Trump’s agenda.

One possibility already hinted at by the House of Representatives is cuts to Medicaid, the joint federal and state program that helps with medical costs for people whose income and resources are very limited. 

While the plan is in the early stages, it would direct the committee that oversees Medicaid to reduce the amount the federal government spends in a way that all but guarantees cuts to the program. 

Medicaid provides insurance coverage for more than 70 million Americans. In Missouri, the program — called MO HealthNet — covers more than 1.3 million, or one in five people in the state, across different eligibility groups. 

About 70% of Missouri’s Medicaid funding comes from the federal government. And for the adult expansion group – Missourians who could enroll in Medicaid after voters passed expansion for the program in 2021 — the federal government picks up 90% of the tab. 

Missouri’s Republican Reps. Mark Alford, Sam Graves, Ann Wagner, Jason Smith, Bob Onder and Eric Burlison all voted for the House budget proposal. Democratic Reps. Emanuel Cleaver and Wesley Bell voted against. The measure narrowly passed 217-215. 

Despite voting for the proposal, Smith, who chairs the powerful House Ways and Means Committee, said Thursday he had doubts over whether the accounting House Republicans used in the proposal will abide by Senate rules. 

Cuts to expansion could mean about $560 billion in savings for the federal government over a decade. House Republicans want to use that savings to help pay for extending Trump’s 2017 tax cuts and other programs like border security, energy and defense spending. The extension is expected to cost $4.5 trillion. 

Trump said last week that Republicans “wouldn’t touch” Medicaid, Medicare or Social Security in their hunt to cut funding. 

Who relies on Medicaid in Missouri? 

The 2021 vote in Missouri expanded who was eligible to enroll in Medicaid in the state to adults who make up to 138% of the federal poverty level. The expansion opened the door for about 340,000 Missourians to enroll in the program. Prior to Medicaid expansion under the Affordable Care Act, Medicaid was mostly restricted for those who were disabled, elderly or pregnant. 

Rural Missourians rely more heavily on Medicaid expansion than Missourians in other areas. An analysis from the Georgetown University Center for Children and Families found that in rural Missouri, 15.2% of non-elderly adults were enrolled in Medicaid, compared to 12.2% in urban areas. 

The trend is similar for children in Missouri — 38.3% of rural children rely on Medicaid or the Children’s Health Insurance Program (CHIP), compared to 35.5% of urban children. 

Across the country, 41 states and Washington, D.C., have expanded Medicaid. Some states, like Illinois, have trigger laws that reverse expansion if funding from the federal government is reduced. 

Missouri and six states passed Medicaid via ballot measures, meaning the legislature cannot pass changes to the expansion without voter approval. 

How Missouri pays for Medicaid 

If the entire federal match for covering Medicaid expansion for the 340,000 Missourians were eliminated, it would cost the state $7.3 billion annually, according to an analysis by the Kaiser Family Foundation. 

Representatives from the department that oversees Missouri’s Medicaid program told lawmakers that the state could stand to lose between $30 million to $35 million for every percentage point decrease in the rate that the federal government pays for the program. 

If all states across the country were to absorb the cost of the federal government’s 90% match rate, states’ spending on Medicaid would increase by 17%, or about $626 billion. 

Republican Sen. John Hawley of Missouri announced that he filed an amendment in the Senate to prohibit budget cuts for Medicaid. 

“I would not do severe cuts to Medicaid,” Hawley told the Huffington Post. 

Congressional, statewide lawmakers search for other places for Medicaid cuts 

Another path Congressional Republicans are exploring for budget cuts includes imposing work requirements for Americans who seek health insurance coverage through Medicaid. 

Rep. Jim Jordan, a Republican from Ohio, said lawmakers may pursue work requirements, which would result in a lower rate of cuts compared to reducing or eliminating the federal match rate.  

Missouri’s Rep. Mark Alford, who gained national attention after a rowdy town hall in Belton, said that he would vote in support of work requirements for Medicaid. Last month, Rep. Bob Onder posted about his support for work requirements, calling it “good policy.” 

An analysis from the Center on Budget Policy and Priorities found that work requirements would put about 36 million Americans at risk of losing their Medicaid coverage, including about 457,000 in Missouri as of June of last year. 

During Trump’s first term, work requirements were an option for spending cuts his administration explored. His administration encouraged states to adopt certain waivers that only allowed Medicaid coverage if individuals met work and reporting requirements. 

Arkansas was the only state to implement work requirements from the waiver, before a federal court said the requirements were against the law. About 18,000 people lost coverage as a result. 

It’s a path lawmakers in Missouri are now considering, citing interest from the federal government in pursuing similar plans. 

Missouri state Sen. Jill Carter, a southwest Missouri Republican, is sponsoring a constitutional amendment to require Medicaid enrollees to work or participate in activities like school, volunteering or job searching to be eligible for the program. It would only go into effect with voter approval.

Medicaid cuts via work requirements in Missouri 

Carter’s proposal would apply to able-bodied Missourians ages 19 to 49 who are enrolled in Medicaid. They would be required to complete and document 80 hours a month of work or other activities. 

Data show that most adults who are enrolled in Medicaid are working or face barriers to finding work. A KFF analysis of work requirements found that 44% of adults on Medicaid aged 19-64 are working full time, while another 20% are working part time — about 16.6 million people. 

Among adults who were not working, 12% cited caregiving responsibilities, 10% cited illness or disability, 8% cited retirement or difficulty finding work and another 7% cited school. 

Estimates from the Congressional Budget Office found that if work requirements were passed, they would impact about 15 million Americans and 1.5 million people would lose eligibility for federal funding. 

The report found that the federal government would save about $109 billion over a decade and it could result in about 600,000 becoming uninsured. It also found that imposing work requirements leads to little increase in employment, due to disability or caregiving responsibilities cited by those who currently do not work. 

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