Will Humble Behavioral Health, Medicaid, State Legislature, Wills Blog

The High Stakes of Medicaid Cuts: What Arizona Stands to Lose

(and a simple solution)

Some in congress and the incoming administration have suggested they’ll be making major changes to Medicaid this congressional session – especially those elements that were associated with the affordable care act like the expansion population – in particular how the expansion population was funded (persons between 100% and 138% of poverty).

While Arizona did expand Medicaid to that population the legislature made the expansion contingent on the federal government paying at least 80% of the cost of the expansion population.

Importantly, the legislature also tied the hospital assessment, which pays the state match for the more than 450,000 childless adults to the federal government continuing to pay at least 80% of the expansion population.

In other words, the childless adult coverage (made possible by the hospital assessment) would also end if the fed’s stop paying for at least 80% of the expansion populations costs.

The Human Costs of Rolling Back Medicaid in Arizona

Medicaid is a lifeline for more than 2.5 million Arizonans, including 500,000 childless adults who regained coverage through a $570M assessment on hospitals which pay for the state match to the feds to fund coverage for childless adults. Thousands of who face significant behavioral health challenges, including serious mental illnesses.

The funding for this population hinges on a critical provision: the federal government must cover at least 80% of the costs for the Medicaid expansion population.

If this threshold isn’t met, AHCCCS coverage ends for both the expansion population and childless adults because AHCCCS would no longer be able to collect the hospital assessment that pays for the state portion to cover childless adults.

Behavioral & Public Health Impacts

For childless adults, access to Medicaid often means access to life-saving care, including treatment for substance use disorders, mental health counseling, and medications.

Without this coverage, many individuals with SMI would face a grim reality: untreated illnesses, emergency department visits, and increased rates of homelessness and incarceration. And yes, death.

Behavioral health services aren’t just a moral imperative; they’re a cost-saving measure. Research consistently shows that access to Medicaid reduces uncompensated care costs for hospitals and lowers overall healthcare spending by addressing health issues before they escalate.

The Financial Reality

Arizona’s Medicaid expansion is funded through a $570M hospital assessment that covers the state’s share of costs. However, this funding mechanism is tied to the federal government maintaining at least 80% coverage of the expansion population. If federal funding drops below this threshold, the hospital assessment would no longer be valid.

The state would then face two choices:

  1. Decouple the hospital assessment from the 80% requirement: This would allow Arizona to continue funding Medicaid expansion, but it would require legislative action, which may face significant political hurdles.
  2. Cover the $570 million state match through the general fund: Given Arizona’s budget constraints, this scenario is unlikely, leaving hundreds of thousands without coverage.

The Broader Impact

Losing Medicaid coverage for childless adults would strain Arizona’s healthcare system and social services. Hospitals would see an increase in uncompensated care, driving up costs for all Arizonans. Public safety systems would also bear the burden, as untreated behavioral health issues often lead to incarceration, repeated hospitalizations, homelessness and death.

AZPHA urges the Arizona State Legislature to proactively protect coverage for childless adults this legislative session by decoupling the hospital assessment from the requirement that the federal government pay at least 80% of the costs for the distinctly different expansion population.

See the statute authorizing the Hospital Assessment which pays for covering ‘Childless Adults’ (ARS 36-2901.08)

We Need a ‘Childless Adult and Behavioral Health Protection Act’

Failure to proactively act to decouple the hospital assessment from the expansion population match requirement would jeopardize the health and well-being of our most vulnerable residents and strain our healthcare infrastructure beyond repair… and it’s a simple fix – simply eliminate ARS 36-2901.08(E) – let’s call it the Childless Adult and Behavioral Health Protection Act by simply deleting ARS 36-2901.08(E).

36-2901.08. Hospital assessment

E. The administration shall not collect an assessment for costs associated with service after the effective date of any reduction of the federal medical assistance percentage established by 42 United States Code section 1396d(y) or 1396d(z) that is applicable to this state to less than eighty per cent.

AZPHA has been doing some pre-session work to ensure that such a bill is filed this session. More to come when we know the bill’s number.

Medicaid funding cuts could put thousands of Arizonans in peril

Medicaid Expansion is a Red and Blue State Issue | KFF

Will Humble Emergency Management, EMS, Wills Blog

Alternatives to Law Enforcement Responses to Mental Health & Substance Abuse Improves Outcomes & Reduces Crime

There is growing consensus that traditional law enforcement in addressing mental health crises is not leading to good outcomes and needs to be overhauled.

Police officers often serve as first responders to mental health and substance abuse crises even though they’re often poorly trained or professionally and emotionally unequipped to manage such incidents. The inefficient response by law enforcement staff has high costs and often results in poor outcomes.

Alternatives to Law Enforcement Responses to Mental Health & Substance Abuse Improves Outcomes & Reduces Crime

The evidence base is being built showing that alternative “community responses” to 911 calls involving mental health or substance abuse reduces costs, improves outcomes and reduces overall crime.

For example, this new study entitled A community response approach to mental health and substance abuse crises reduced crime documents how a pilot in Denver that directed targeted 911 calls to health care responders instead of the police.

The authors found robust evidence that the program reduced crimes like trespassing, public disorder, and resisting arrest by 34%. The sharp reduction in targeted crimes reflects the fact that health-focused first responders are less likely to report individuals they serve as criminal offenders and the spillover benefits of the program (e.g., reducing crime during hours when the program was not in operation).

Another essay in Scientific American: Sending Health Care Workers instead of Cops Can Reduce Crime makes a compelling argument that non-police-centered strategies not only are better at reducing crime; they’re less expensive & don’t come with the negative lateral consequences associated with policing.

In part, that’s because law enforcement is poorly equipped to resolve mental health or substance abuse issues in the field and tend to default to transport to emergency departments and arrests, both of which are extremely expensive and not associated with good outcomes.

HBO has captured the San Antonio Police Department’s pioneering crisis intervention approach in an Emmy Award-winning documentary, and Vitalyst is pleased to be offering free virtual screenings.

Ernie, Joe, and Behavioral Health Crisis Best Practices

As communities reckon with the behavioral health impacts of the pandemic and more, the work modeled by Ernie and Joe in this documentary is more important than ever. All Arizonans are encouraged to view the full documentary via HBO, and our first responders are urged to click here to register today for their free regional screening events. 

Phoenix Pilot Innovations Under Way

The City of Phoenix recently implemented a pilot Psychiatric Emergency Response Team intervention which integrates police officers with mental health clinicians. The PERT model is a critical shift in how communities address behavioral health crises.

Inside the special Phoenix police team that calms mental health crises

Officers in the program receive specialized training to recognize and respond to mental health challenges, while clinicians on the team provide expert support to assess needs and recommend care pathways.

These approaches, including Crisis Intervention Training (CIT) for officers and co-responder models like PERT, emphasize collaboration and compassion. Research has consistently shown that such interventions improve outcomes for individuals in crisis, reduce repeat interactions with law enforcement, and even lower crime rates.

In Phoenix, the program’s benefits extend beyond individual outcomes. By diverting cases that would otherwise result in arrests or emergency department visits, PERT reduces strain on the criminal justice and healthcare systems. This efficiency creates a ripple effect, freeing resources to address more pressing public safety and health issues.

However, as promising as the PERT model is, it should be part of a broader strategy to address the root causes of behavioral health crises. Investments in affordable housing, accessible mental health care, and substance use treatment are essential. Addressing social determinants of health can prevent crises from occurring in the first place, reducing the need for emergency interventions.

Will Humble Health Insurance, Wills Blog

Why is the U.S. Healthcare Delivery System so Confusing, Fragmented, & Expensive Compared to European Democracies?

America’s fragmented healthcare insurance system is rooted in its unique historical and political development, which diverged significantly from European democracies just after WWII.

After the war, most European nations began adopting centralized, government-funded healthcare systems driven by industrialization, labor movements, and the need to manage public health crises.

In contrast, the U.S. relied on a decentralized, market-driven approach, shaped by an emphasis on individualism and distrust of government. The absence of a strong labor party in the U.S. compared to Europe (which championed universal healthcare) also played a key role.

The modern American health insurance system appeared during and just after World War II.  After the war American employers began offering health insurance as a fringe benefit to attract workers. In 1943, a tax exemption for employer-sponsored insurance locked in the employer-based health insurance – making it the dominant way Americans accessed healthcare coverage.

This tied healthcare access strictly to employment – handcuffing people to their jobs & limiting job mobility for decades (until the Patient Portability & Affordable Care was passed in 2010).

Efforts to create a universal system in the US during the 40s and 50s faced political roadblocks. President Truman proposed a national health insurance plan, but it was defeated because of opposition by the American Medical Association and other powerful interest groups.

Meanwhile in Europe, country after country was setting up universal care systems as post-war reconstruction and organized labor encouraged national solidarity and collective health solutions. While that was happening, the U.S. expanded its fragmented system in a patchwork fashion.

Public programs like Medicare and Medicaid were passed during the Johnson Administration (1965) to cover seniors, low-income individuals, and those with disabilities… but those laws only filled specific gaps.

Private insurance continued to dominate for the working-age population for decades, leading to inconsistent coverage, large health insurance middlemen, and with non-profit and for-profit bureaucracies tasked with rationing care for private health insurance plans offered by employers (while making a hefty profit), resulting in rising costs and greater fragmentation when compared with our European peers.

In 2010 the Patient Portability and Affordable Care Act was passed that finally broke the bonds between employment and access to insurance, required insurers to cover people with pre-existing conditions, and provided a way for people to get health insurance outside their formal employment- finally allowing people to go out on their own as entrepreneurs without risking their family’s healthcare.

Even after the ACA, however, the US has a patchwork system when compared to Europe because of entrenched interests (US health plans that are quite profitable), cultural attitudes, and the difficulty of overhauling such a complex structure.

Meanwhile, European nations streamlined healthcare delivery through government-run or heavily regulated systems, ensuring universal access and cost controls.

The result? Healthcare costs in the U.S. are significantly higher than in European countries, with the U.S. spending over 16% of its GDP on healthcare, compared to 9-12% in the EU countries.

Per capita, the U.S. spends approximately $12,000 annually, nearly double that of countries like Germany and France. Despite higher spending, U.S. life expectancy lags, averaging 76 years, compared to 80+ years in much of Europe.

The cost discrepancy stems from administrative overhead, higher drug and procedure prices, and fragmented care in the U.S., while Europe’s centralized systems provide more efficient, fair, and achieve better health outcomes for less money (although of course public health, behaviors and the social determinants of health also play a role in the US lower life expectancy).

Will Humble Affordable Care Act, Health Insurance, Healthcare, Public Health, Wills Blog

What to Do When Your Health Insurer Denies Your Claim or Treatment: A Guide for Arizona Consumers

The recent killing of a UnitedHealthcare executive has started a national dialog about the frustrations many patients, families, and doctors have when their health insurance company denies treatment, unfairly won’t authorize care, has unreasonable prior authorization rules and/or just plain refuses to pay legitimate claims.

These denials of care often, maybe even usually, happen during the most difficult times in a patient’s or family’s life. The national resonance has been palpable – probably because so many people have been denied care.

Thankfully, consumers have some protections because of federal laws like the Employee Retirement Income Security Act (for employer-sponsored plans) as well as under the Affordable Care Act for Marketplace plans. There are also some limited protections in state law.

When your claim is denied, health insurers must provide a detailed explanation of the denial, including references to the specific plan provisions on which the denial is based. Consumers also have the right to request their entire claim file, which includes all documents, records, and other information related to the denial.

Steps you can take when your insurance company denies a claim or doesn’t authorize payment for treatment:

Try to Understand the Denial 

Review the explanation of benefits or denial letter from your insurer. Common reasons include errors, lack of preauthorization, or disputes over coverage.

Contact Your Insurer

Badger your insurer to clarify and address the denial. Sometimes, issues can be resolved with more documentation or corrections. Be a squeaky and bothersome wheel.

Ask Them for (demand) Your ‘Claim File’

A claim file is a collection of the information your insurer used to decide whether it would pay for your medical treatment or services. Claim files include internal correspondence, recordings of phone calls, case notes, medical records and other relevant information. Information in your claim file is critical if you end up needing to appeal your claim denial.

ProPublica’s Claim File Helper lets you customize a letter requesting the notes and documents your insurer used when deciding to deny you coverage. Get your claim file before submitting an appeal.

Claim File Helper: Request Your Claim File — ProPublica
File an Appeal

If you’re still having trouble you may need to file an appeal. Every insurer has a specific process for filing appeals, outlined in your policy or the denial letter:

  • Write a formal appeal letter using info from your Claim File.
  • Include supporting documentation (e.g., medical necessity letters from your doctor).
  • Submit your appeal within the specified deadline (often only 30–180 days from the denial date).

The Affordable Care Act requires insurers to offer an internal appeals process if you have Marketplace plan. If denied again, you can request an external review by an independent third party. How to appeal an insurance company decision | HealthCare.gov has some information on that process.

Internal appeal: If your Marketplace Plan claim is denied or your health insurance coverage canceled, you have the right to an internal appeal. You may ask your insurance company to conduct a full and fair review of its decision. If the case is urgent, your insurance company must speed up this process.

External review: You have the right to take your Marketplace Plan appeal to an independent third party for review. This is called an external review. External review means that the insurance company no longer gets the final say over whether to pay a claim.

File a Complaint with ADIFI

You can also file a complaint with the Arizona Department of Insurance and Financial Institutions. They’re supposed to investigate claims and ensure insurers follow state regulations (which are not rigorous by the way). You can file your complaint. You can file your complaint with ADIFI here.

Dealing with a refused prior authorization, unreasonable prior auth requirements and denied claims is frustrating and even scary because it often comes at a really hard time in a person’s life. But… not giving up and advocating for yourself and your family with the strategies above might make a difference… and remember you might be able to dump your carrier during your next open enrollment.

Understanding Health Insurance challenges and claim denials – Arizona Horizon
Will Humble Social Determinants, Wills Blog

Is the Incoming President Allowed to Use the Military to Enforce Immigration Laws?

The president elect has suggested over and over that he will declare a national emergency in order to use the U.S. military to enforce immigration laws and help with a yet to be detailed ‘deportation force’.

 I did a little research to try to figure out whether using the military in that was is legal or not. Here’s what I found:

The President has limited authority to use the U.S. military for domestic law enforcement due to legal restrictions like the Posse Comitatus Act of 1878.

Posse Comitatus Act

The Posse Comitatus Act is a federal law enacted in 1878 that limits the use of the U.S. military in enforcing domestic laws. Its purpose is to keep a clear distinction between civilian law enforcement and military operations.

Here are some of the details with that law:

The PCA prohibits the use of the military to enforce domestic laws unless explicitly authorized by the Constitution or Congress and specifically prohibits the military from being used for:

  • Arrests
  • Searches and seizures
  • Investigations
  • Crowd control
Exceptions to the PCA

The President can deploy the military domestically in specific circumstances to enforce the Insurrection Act which lets the President to use federal military forces to:

  • Suppress insurrection or rebellion.
  • Enforce federal law when local authorities are unable or unwilling to do so.

The Insurrection Act also would apparently let the military (under some circumstances) help Customs and Border Protection in a support role, providing surveillance, logistics, and other non-law enforcement activities.

For example:

  • Presidents have deployed the National Guard to help with border security under Title 32 of the U.S. Code, which allows states to use their National Guard forces in coordination with federal missions.
  • Active-duty military personnel have been used at the southern border for non-law enforcement roles, such as erecting barriers or providing technical help.
National Guard

The National Guard operates under dual state and federal authority. Governors can deploy the National Guard for law enforcement within their states. When federalized, the National Guard is subject to the same restrictions as active-duty military forces.

This is an important distinction in the event that the national guard in a state like Texas is federalized and tasked with domestic law enforcement actions.

Next week I’ll do a dive into what it would take and what the boundaries are for presidents to declare martial law to exercise otherwise illegal actions.

 

Will Humble Social Determinants, Wills Blog

Affordable Housing Policy: It’s Not All Gloom and Doom

It’s no secret that Arizona has an affordable housing crisis. It’s not unique to Arizona – but some of the most acute effects are being experienced here. While the crisis is still acute – at least housing and homelessness are widely recognized as being a community and public health crisis and policy makers are beginning to respond.

While the large-scale efforts to compel recalcitrant cities to humanize their overly restrictive zoning restrictions contributing to the lack of housing supply, there were some good policy movements last legislative session. Let’s start with the state legislature.

State Legislature

There were 4 modest housing reform bills that were passed last session that over time will make some difference, three of which go into effect on January 1 (one goes into effect January 1, 2026).

  • HB2720: Cities with more than 75K residents will need to modify their zoning regulations to allow ‘accessory dwelling units’ aka casitas, on lots zoned for single-family use by Jan. 1, 2025.
  • HB2297: Cities with 150K people will need to allow apartments on up to 10% of commercial, office or mixed-use buildings by Jan. 1, 2025. The law also includes language to speed up the zoning process.  Sadly, Scottsdale set up their rules and practically won’t allow any (only 1%)  – perhaps sparking a fistfight with the legislature this session.
  • SB1162: Under this new law, cities will need to install zoning code changes that speed up the approval process for construction. The localities also have to publish a housing needs assessment every five years and outline the total need for added housing through population and job growth data and how much of a locality’s land is zoned for housing, starting Jan. 1, 2025.
  • HB2721: Under this law that will take effect 1/1/26, cities with 75K people will need to allow for the development of duplexes, triplexes and other multi-family home options on lots zoned for single-family use.

State Agencies

There are also some things happening at the state agency level that are encouraging. For example, the Arizona Department of Housing is using the Arizona Housing Trust Fund to address housing instability and develop housing solutions across the state. Key initiatives include:

  • Affordable Housing Development: Over $62 million has been allocated to create new affordable housing units, addressing the critical housing needs of low-income families and individuals​
  • Transitional and Permanent Housing: Investments include $9 million for transitional housing and homeless shelters, $7.5 million for permanent supportive housing, and $4.7 million for youth homeless shelter facilities​
  • Rental Assistance and Eviction Prevention: A significant portion of funding, $17.7 million, supports rental assistance programs and eviction prevention to stabilize families at risk of homelessness​
  • Support Services: Funding also supports operational services for homeless shelters, case management, utility assistance, and employment and education programs. For example, $6.3 million was given for these supportive services, enhancing long-term housing stability​​

AHCCCS is also stepping up to the plate by implementing a new waiver that follows a ‘Permanent Supportive Housing Model an evidence-based and cost-effective strategy for addressing & improving health outcomes for persons with a serious mental illness.

This intervention will also be key for reducing homelessness – as nearly of those experiencing homelessness in Arizona have an SMI designation, highlighting the disproportionate burden on this population.

AHCCCS is also funding a new facility on the grounds of the AZ State Hospital that will provide ‘bridge housing” for persons with behavioral health needs.

The facility will have a separate (physically attached) outpatient behavioral health service setting. When completed, it’ll have capacity for approximately 70 people (w/privacy).

Related:

AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program – AZ Public Health Association

What Gets Measured Gets Done: Tackling Housing & Incarceration Challenges for Persons with Serious Mental Illness – AZ Public Health Association

AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program – AZ Public Health Association

Arizona’s Worsening Public Health Heat Crisis: A Plea for Housing Reform – AZ Public Health Association

New Facility on AZ State Hospital Grounds to Provide Bridge Housing for Persons Experiencing Homelessness with Mental Health Needs – AZ Public Health Association

Updating Arizona’s Landlord-Tenant Act: A Crucial Step to Prevent Evictions and Save Lives – AZ Public Health Association

Will Humble Oral Health, Public Health, Wills Blog

Water Fluoridation is Good for Public & Oral Health

In addition to his desire to halt immunizations in the US, Robert F. Kennedy Jr. is also urging cities to stop fluoridating their public water systems.

While Kennedy wouldn’t have the authority to directly stop fluoridation if confirmed as the HHS Secretary, he could alter CDC guidance so as to discourage water fluoridation, causing many communities to reconsider this essential public health measure. This is troubling, especially since his stance is, once again, not backed by evidence.

Community Water Fluoridation Evidence Review: Mel & Enid Zuckerman College of Public Health

Fluoridating water to optimal levels is one of the greatest public health achievements of the 20th century, according to the CDC. It prevents tooth decay across all age groups and socioeconomic statuses, saving families and communities money on dental care.

Ten Great Public Health Achievements 2001–2010

About Community Water Fluoridation | Fluoridation | CDC

In Arizona, where dental care access is already uneven, fluoridated water has been a key to improving overall oral health at the community level, especially for children and low-income families, who are more likely to suffer from cavities.  About 58% of the state’s population benefits from fluoridated public water.

Without fluoridation, these Arizonans would face higher rates of oral disease, worse health outcomes, and increased dental costs​.

Communities of 1,000 or more people see an average estimated return on investment of $20 for every $1 spent on water fluoridation.

The ROI for community water fluoridation increases as the community size increases, but even small communities save money for their residents and cities with fluoridated water save an average of $32 per person a year by avoiding treatment for cavities.

Kennedy’s pattern of promoting pseudoscientific claims is well-documented. From vaccines to water fluoridation, he often ignores mountains of scientific evidence to chase fringe ideas. His opposition to fluoridation, despite decades of research proving its safety, risks undermining public health progress.

CDC Scientific Statement on Community Water Fluoridation | CDC

If the CDC revised its guidance under Kennedy as HHS Secretary, some or many cities would likely stop fluoridating their water, leading to preventable cavities, poorer oral health, and higher healthcare costs, particularly in low-income communities.

Note: CDC does not mandate community water fluoridation. The U.S. Public Health Service (USPHS) recommended fluoride level is not an enforceable standard.

The U.S. Public Health Service (PHS) Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries is science-based guidance on the optimal level of fluoride in community water supplies.

The PHS panel that provided the recommendation considered all sources of fluoride intake and recommended 0.7 mg/L as the concentration that maximizes fluoride’s oral health benefits while minimizing potential harms, such as dental fluorosis.

Will Humble Public Health, Wills Blog

Public Health Journalism this Week

Preventing child fatalities in Arizona – Arizona PBS

Attorney General Kris Mayes ‘outraged’ by opioid distributor payments

AZ poised to end health care coverage for millions if Trump and Republicans cut Medicaid funding

Connecting through music | Center for Health Equity Research

Pinal County workers have probable bird flu; first humans in Arizona

UnitedHealthcare covers state of Arizona employees, among others.

RSV, COVID-19 cases drastically decrease in Arizona as flu cases spike

Will Humble Professional Development, Wills Blog

Arizona Public Health Grant Opportunities

Compiled by the Vitalyst Health Foundation

Due November 29th: Centene Foundation (Healthcare Access, Social Services, & Education)

NEW Opens December 1st: Fighting Hunger Grants

Due December 3rd: Science for Nature and People Partnership

Due December 4th: Kroger Giving Back

Due December 4th: Ken Kendrick Grand Slam Awards

Due December 5th: Agriculture and Food Research Initiative Competitive Grants Program

Due December 9th: OneCause Software Grant

Due December 11th: City of Tempe Human Services Funding

Due December 13th: Cohort to Improve the School Food System

Due December 15th: Sundt Foundation

NEW Due December 31st: Medicaid Beneficiary Advisory Council Planning and Implementation (learning collab)

Due December 31st: The Stocker Foundation (literacy & STEAM)

Due January 6th: Annual Seeding The Future Global Food System Challenge

Due January 9th: Regional Infrastructure Accelerator Program

Due January 10th: Farm to School Implementation Grant

Due January 13th: Agriculture Conservation Experienced Services Program

Due January 13th: Building Capacity for Small Organizations To Engage in Patient-Centered Comparative Clinical Effectiveness Research

NEW Due January 15th: Journey for Good Grants (food, workforce, education, and veterans)

Due January 23rd: AmeriCorps State and National Competitive Grants

Due January 23rd: Tribal Clean Energy Planning and Development

Due January 30th: National Infrastructure Investments

Due January 31st: Bloomberg Philanthropies – Asphalt Art Initiative

Due February 28th: Rural Business Development Grant Program

NEW Due March 1st: Endowment for the Arts Grant

NEW Due March 1st: Dr Scholl Foundation

NEW Due March 21st: The Peter and Pat Hirschman University-Community Research Partnership Fund

Due March 31st: Sunset Grant

Ongoing: Arizona Housing Fund 

Ongoing: Arizona Together for Impact Fund

Will Humble Disease Control, Wills Blog

H5N1 Influenza: Birds, Cattle, and Humans

Influenza is a sneaky virus. Perhaps the biggest wildcard with the virus is its ability to mutate. Flu viruses undergo two main kinds of change: routine antigenic drift (small, gradual tweaks) and antigenic shift (big, dramatic changes).

Big (and potentially dangerous) antigenic shifts happen mainly in birds, where different flu strains can swap genetic material, creating entirely new versions of the virus.

Ducks, chickens, and other fowl are the mixing bowl for flu strains, creating combinations that are sometimes capable of infecting mammals. Pigs are usually the next link in the antigenic shift chain because they share respiratory receptors similar to humans.

If a bird flu virus infects a pig, it can further adapt to replicate efficiently in mammals (called ‘reassortment’). When this happens, the virus has the potential to jump to humans, raising concerns about severe illness and even pandemics.

So, where does H5N1 fit into all this? H5N1 is a type of avian flu that has been circulating among birds for decades, occasionally infecting humans. In recent years, its spread has taken a concerning turn, showing up not just in wild birds but also in poultry and, most recently, mammals—including cattle.

The Current Situation

According to the CDC and USDA, H5N1 infections in birds have increased dramatically in the last year with widespread outbreaks among wild and domestic flocks.

The virus is now present in every state including spillover to mammals like foxes, raccoons, polar bears and cattle. While cattle don’t seem to transmit the virus, infections highlight how H5N1 is adapting to new hosts – potentially leading to a reassortment event where the virus becomes easily transmissible among humans.

Surveillance and Response

To stay ahead of the virus, extensive surveillance efforts are underway. The USDA and wildlife agencies are testing birds, while state and federal animal health officials are closely watching cattle herds. CDC is coordinating with state health departments to track potential cases and support readiness for larger outbreaks.

H5 Bird Flu: Current Situation | Bird Flu | CDC

Meanwhile, public health and animal health experts are collaborating to implement interventions like culling infected bird flocks, restricting animal movements, and implementing stricter biosecurity practices on farms.

For humans, the focus right now is on educating those at risk—like poultry workers—about proper protective gear and vaccination options.

H5N1 hasn’t yet made the leap to efficient human-to-human transmission. But the situation demands vigilance because it could happen.

H5N1 is a reminder that flu viruses are dynamic and unpredictable. Continued surveillance and a coordinated response will be key to keeping this virus in check—for birds, mammals, and humans.

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