About aslessarev

Alexandra Slessarev is a third-year JD/MPH student at Harvard. Her public health research interests include maternal and reproductive health, state-level Medicaid implementation, and the intersection of health and the environment. Prior to starting her dual-degree program, Alexandra spent a year working as a research assistant at the Bixby Center for Global Reproductive Health at the University of California, San Francisco, where she worked on several projects related to long-acting reversible contraception provision and education.

Hurricane Florence and the health effects of climate change

NC hog lagoon

Photo by picstever/Flickr

By Alexandra Slessarev

Among the coverage of the aftermath of Hurricane Florence, news stories about the overflowing waste from North Carolina pig lagoons were among the most stomach-turning. North Carolina is home to a slew of concentrated animal feeding operations, or CAFOs, and these industrial livestock farming operations often involve storing massive volumes of pig manure in contained “lagoons.”

The driving rain from Hurricane Florence caused at least 110 of these lagoons to swell over. CAFOs are, in themselves, a topic of concern among public health and environmental justice advocates. But this specific example of what happens when CAFOs and extreme weather patterns collide provides an opportunity to reflect on the unique relationship between public health and climate change.

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A status update on the Medicaid work requirement landscape

People standing in a line

By Alexandra Slessarev

Earlier this week, Michigan submitted a proposal to the Trump administration requesting approval to impose work requirements on Medicaid expansion beneficiaries. Michigan’s proposal was submitted through the Medicaid Act’s section 1115 waiver program, which allows states to introduce experimental projects that “further the objectives” of the Act. (For a more in-depth discussion of the function of section 1115 waivers in the Medicaid scheme, see Carmel Shachar’s Bill of Health post from earlier this summer.)

Work requirement waivers garnered a rush of attention after the Trump administration issued guidance indicating that it would begin approving such requests. Michigan is now one of twelve states that have submitted a work requirement proposal, with four of those states having successfully received approval from HHS.

This recent development in Michigan provides an opportunity to take stock of the Medicaid work requirement landscape since the Trump administration began approving the waivers. Continue reading