Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names
Work Requirements Unfairly Burden Medicaid Applicants
Great story (“A Deloitte-Run System Denied Medicaid Benefits for Michigan’s Disabled. Now Trump’s Law Piles On,” July 21). However, a key point was missed. The wrongly denied recipients have the burden of proving their entitlement. This can cost thousands. They have no money with which to finance the carrying of that burden of proof. Additionally, how does one prove that they cannot do any work? Doctors generally say: I will just provide their work restrictions (e.g., 10-pound lifting restrictions), but I’m not a vocational expert, so I’m not going to opine on “employability” or “non-employability.” Moreover, it takes many months to go through reconsiderations and appeals, so even if the worker wins, they will have lost everything by then. Finally, under the doctrine of “exhaustion of remedies,” the recipient must suffer through the administrative steps before asking a court to help. And even then, the court will defer to the administrative agencies’ findings of fact (i.e., the department’s hired doctor over the treating doctor).
Bottom line: Once there is an incorrect/wrongful denial, it is an unjust horror show that literally destroys lives — all because far-right politicians have stereotyped Medicaid recipients, painting them all as presumptively people who could work but would rather just unjustly receive benefits — a totally false and ignorant paradigm. A partial solution would include placing the burden of proof on the state to prove the recipient can work and that suitable work is available, and to enact a presumption that when a treating doctor has credibly explained a substantial disability, the department must presume qualification absent clear and convincing proof to the contrary.
— N. Dean Nasser Jr.; Sioux Falls, South Dakota
A Reckless Data Grab?
The Office of Personnel Management has already suffered massive data breaches affecting millions of employees and their families
I am a retired federal civil servant and one of the many whose data was stolen in 2015
The latest federal actions (“Trump’s Personnel Agency Says It Will Remove Some Identifying Info as It Sweeps Up Medical Records,” July 22) raise the question of how the requested massive dump of health data can be safeguarded any better than the personnel records previously affected
— Kathryn Edgecomb; Vancouver, Washington
States Need More Than Money To Fight the Opioid Crisis
New Mexico offers a compelling case study in the national conversation about opioid settlement accountability (“Leadership Vacuum: Agencies in New York and Beyond Pass the Buck on Opioid Cash Oversight,” July 21). While much of the public attention has focused on whether settlement dollars are being misspent, the New Mexico Office of the State Auditor’s review of local governments found a different problem: Large amounts of opioid remediation funding remain unspent years after settlements were reached and funds were distributed. The state auditor’s transparency review identified more than $100 million in opioid settlement funds held by local governments, with many entities reporting little or no expenditures as of fiscal year 2025.
That outcome does not point to widespread misuse. Instead, some local officials repeatedly cited workforce shortages, provider capacity constraints, procurement hurdles, and long-term sustainability concerns as barriers to moving dollars into prevention, treatment, and recovery programs
While these barriers are significant, New Mexico has built structures that may be worth watching. A state law established dedicated opioid settlement funds and a framework intended to ensure resources are used for opioid remediation purposes. State agencies, local governments, behavioral health providers, and policymakers are now working through how best to coordinate spending, measure outcomes, and communicate progress to the public. The New Mexico Office of the State Auditor will continue to provide transparency, reporting on who is spending, what is producing results, and where bottlenecks exist.
The lesson for other states is clear: Securing settlement dollars creates an unprecedented opportunity to remediate harms resulting from the opioid crisis, but it is only the first step. States also need the workforce, infrastructure, and coordination to turn that money into treatment, recovery services, prevention programs, and fewer overdose deaths
The core question is no longer just where the money is. It is whether states have built the systems to translate settlement dollars into measurable public health gains
— New Mexico State Auditor Joseph Maestas; Santa Fe, New Mexico
Progress on the Prior Authorization Front
Health plans continue to make steady progress implementing the multiyear series of voluntary commitments to simplify prior authorization. The article “Insurers Hedge on Trump-Backed Pledge To Improve Denials Process” (July 17) paints an incomplete picture of this ongoing work, particularly related to supporting continuity of care for patients and standardized submissions for prior authorization requests
Participating health plans committed to implementing six reforms aimed at reducing administrative burden and accelerating access to care on a transparent timeline, and that work is on track. In April 2026, participating health plans announced the elimination of 11% of prior authorizations and a standardized approach for submitting electronic prior authorization requests for most medical services starting in 2027
Health plans will continue adopting common data standards on a rolling basis as the standardization commitment is fully implemented, starting in 2027. As more providers move away from manual, error-prone processes and adopt electronic prior authorization, this standardized approach will mean faster answers, a more consistent experience, and less friction for everyone
All participating plans have continuity of care programs in place to support member transitions between insurers during an active course of treatment. Under the voluntary commitments, when a patient with an approved authorization for in-network care switches health plans, the previous plan’s authorization is honored for 90 days. Health plans can implement several data exchange options to support patient transitions, and plans are not required to use a specific method to meet the commitment
The series of voluntary commitments made by the industry requires substantial work, meaningful investment, and strong partnerships. Health plans are making steady progress in meeting these commitments and will continue to do so until they are fulfilled
— Mike Tuffin; AHIP president and CEO; Washington, D.C
