CORRECTION: This web-version of the story initially listed Rep. Dusty Johnson as "Rep. Dusty Johnson, R-N.D." It has since been corrected to reflect that he represents South Dakota. (10:35 a.m. CT, April 23, 2025)

A bus tour will zip through eastern South Dakota Thursday, where local leaders, health care providers and farm voices want to connect the dots between stable federal aid and their ability to plan, after recent actions have put them in a tough spot.

Thursday's events are part of the rural community tours organized by United Today, Stronger Tomorrow, a coalition that contends heavy budget cuts and grant freezes carried out by the Trump administration are the opposite of creating efficiencies.

Thursday's tour will stop in Madison, which is part of a new, largely federally funded tristate pipeline to improve water quality and economic development.

Roy Lindsay, mayor of Madison, said his city of about 7,000 cannot build a stronger future without the help of federal programs.

"It seems like whoever's pushing the buttons are looking at numbers more than (the) reality of what those departments actually mean," Lindsay observed.

Local officials echoed demands from voters who have shown up at town halls asking their members of Congress to push back against cuts. In an emailed statement, Rep. Dusty Johnson, R-S.D., said he understands the concerns but cited the federal debt as a need to, in his words, "right-size our government."

Farming communities said they are stuck in a holding pattern due to downsizing within the U.S. Department of Agriculture, including conservation grants.

Travis Entenman, executive director of the Northern Prairies Land Trust, which works with private landowners on projects, said in a "red" state, it is already hard to convince people to try out federal programs and he fears the funding dilemma will hinder progress.

"The uncertainty of it all, and the back and forth, and no one really knows what's going on, makes it extra frustrating," Entenman explained.

Entenman acknowledged not every farmer who applies for the grants gets one but added those who do have come to expect reliability in receiving funds as they work to make their farmland healthier and economically viable.

A federal judge ordered the Trump administration to "unfreeze" affected conservation grants, but Entenman and other South Dakota groups said they have yet to see evidence of money flowing again.

As Congress continues to push for cuts and additional work requirements for Medicaid eligibility, experts warn more Kentuckians could lose access to treatment for substance use disorders.

The U.S. House has already passed a budget bill, which by some estimates would slash federal spending for Medicaid by around $700 billion.

In 2020, nearly 30% of all Medicaid recipients in Kentucky used at least one substance use disorder service and in 2021, more than 54,000 were receiving treatment for opioid use disorder.

Ashley Spalding, research director at the Kentucky Center for Economic Policy, said the program is critical for people in recovery.

"They're getting prescription medications that are evidence-based for treating opioid use disorder," Spalding explained. "If these cuts go into effect, then people are going to lose access to their treatment, to their prescription medications."

Medicaid funding is used for medications like suboxone and methadone, harm reduction tools such as Narcan and fentanyl strips, and other community-based services. According to federal data, last year overdose deaths in the Commonwealth decreased for the third year in a row and decreased among Black Kentuckians for the first time, according to state data.

A decade ago, Kentucky expanded Medicaid and relies on federal funding for 90% of the program's budget, nearly $6 billion. Spalding worries counties could see the positive trends in overdose deaths reverse if providers get fewer federal dollars and expansion is rolled back.

"We know that people, particularly in rural parts of the state, there are very high rates of overdose. That's the case for Black Kentuckians as well," Spalding pointed out. "We want to see the state move forward on this really critical health issue."

A new report from the National Bureau of Economic Research showed states choosing to expand Medicaid saved more than 27,000 lives between 2010 and 2022.

Minnesota lawmakers remain in crunch time mode in getting a budget passed, with a special session needed and there is spirited debate about whether health coverage for undocumented adults should be included.

Earlier this year, the state expanded eligibility for its public health insurance program MinnesotaCare to cover those without legal status. With a projected deficit forecast for 2028 and 2029, GOP lawmakers said the expense should be cut. A compromise would keep the benefit in place for children in such situations.

Alexandra Fitzsimmons, senior policy director for the Children's Defense Fund Minnesota (CDF-MN), warned about removing it for their caregivers.

"We want people to be accessing the care for preventive visits, for chronic conditions and things like that," Fitzsimmons explained. "Because we know when people are healthier, they're better able to care for their children."

She added it can include households where grandparents are the caregivers. According to state data, roughly 17,000 Minnesotans who are noncitizens have enrolled since Jan. 1. The Department of Human Services only received about 4,300 claims for health care services in the first quarter. The state only pays claims after services are administered, with current costs at nearly $4 million.

Advocates said there is misinformation out there about how much money the state will spend on expanded eligibility. Republicans argue the current enrollment pace is higher than initially predicted.

Rep. Jeff Backer, R-Browns Valley, said earlier in the legislative session it would be great to help more people, but Democrats need to prioritize.

"We are looking at a tremendous hurt to our system," Backer contended.

Fitzsimmons countered the health care system would feel stress if caregivers are stripped of health coverage.

"We know, too, that if people don't have access to preventive care, they're going to go to the emergency room," Fitzsimmons pointed out.

Immigrant assistance groups and charitable organizations have urged Democratic leaders to reject the compromise, saying it goes against pledges made in 2023 to fully invest in vulnerable populations.

New bipartisan bills in the Ohio Legislature would provide a $2,000 tax credit to working Ohioans who care for family members at home.

The goal is to ease the financial burden for the state's estimated 1.5 million family caregivers, many of whom juggle jobs and caregiving without compensation.

Jenny Carlson, state director of AARP Ohio, said the credit would offer real relief.

"Many Ohio caregivers are balancing caregiver responsibilities with work and are paying for care expenses out of their own pockets," Carlson pointed out. "Averaging between $7,200 and about $14,000 a year depending upon the acuity and level of need of their loved one."

AARP reports Ohio caregivers provide $21 billion in unpaid care annually, often preventing the need for costly nursing home care funded by taxpayers.

Carlson noted the legislation, House Bill 279 and Senate Bill 205, has support from both business and women's advocacy groups, and she argued helping caregivers stay employed is not only a family issue, but an economic one.

"Within the employer community, 32% of the individuals take a leave of absence, 16% turn down promotions, and 16% stop working altogether," Carlson outlined. "Supporting our family caregiver tax credit is just a way to continue to help support the workforce."

The bill sponsors, Rep. Adam Matthews, R-Lebanon, and Sen. Michele Reynolds, R-Canal Winchester, hope the credit will be included in the state budget by July 1. Advocates said Ohio's pilot program could become a model for the nation.