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Missouri approves Medicaid coverage extension to a full year postpartum

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Missouri Gov. Mike Parson signed into law last week a bill that extends Medicaid benefits for new moms from 60 days to a full year postpartum.That extension would have helped Sharron Prather, who suffered from postpartum depression after she gave birth to her son 14 years ago.“I was a first-time mom, my mom had recently passed away, so I had no family here in St. Louis,” Prather said. “And so, I didn’t know what I was doing, you know, being a first-time mom. And I didn’t know what postpartum depression was.”Prather said she couldn’t figure out why she wasn’t connecting with her son.“By the time I found out what it was, it was after my Medicaid had ended, so I didn’t know I could have gotten services with counseling,” Prather said.Because Prather had health insurance through Medicaid, she was covered through her pregnancy plus 60 days after giving birth. She says knowing she had limited time with health insurance added to the stress she was already experiencing.“I tried to think like, I have to try to get my eye exam and I got to try to get my dental in, I have to try to make sure my baby’s got all the immunizations and everything in, within that window. But you’re also still healing from having the baby,” Prather said.

Brian Munoz

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St. Louis Public RadioSharron Prather, 42, of Hazelwood, last Thursday at St. Ferdinand Park in Florissant. Prather said knowing she only had a spattering of months worth of government-backed insurance coverage added to her stress as she was attempting to navigate being a new mom.

Currently, people like Prather, who received health care during their pregnancy through MO Healthnet or the Show-Me Healthy Babies program see the same cutoff of 60 days postpartum. That short time frame of postpartum care means less opportunity to treat health conditions, like hypertension and diabetes, according to Dr. Ebony Carter, a high-risk obstetrician in the St. Louis area.“During pregnancy, we manage to pull them together and try to tie everything in a nice bow and optimize it really well. And then they have the baby, and then they get kicked off,” Carter said. “And then I don’t see them again till their next pregnancy when it’s even more out of control than it was for the first one.”Carter says the extension bill that Parson signed helps the most vulnerable, low-income mothers who often have underlying health issues.“I think knowing that people don’t just fall off of the health care cliff immediately, means that you can continue to engage and support and I hope what this will do is help us to better bridge care back to primary care after pregnancy,” Carter said.Prather, who received health insurance through Medicaid during her pregnancies and births of all three of her children, said she believes having a year of postpartum care would have helped with her healing.“Because I didn’t have that support, I rushed my body because I had to go back to work, I had to do everything so I can pay these bills, because those bills were coming in. Like, after you have your baby. It’s like, ‘Oh, great, yeah, we’ll give you this formula, we’ll give you all that. And then you’re on your own,’” Prather said.

Brian Munoz

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St. Louis Public RadioThe Missouri House of Representatives last January during the first day of the legislative session in Jefferson City. The state’s legislature passed an extension to maternal Medicaid after it was offered by the federal government under the American Rescue Plan which comes to the support of maternal advocates. In Missouri, the rate of mothers who have Medicaid and died during, or within one year of, pregnancy is more than eight times higher than those with private health insurance, according to a state study.

Missouri joins a growing number of states addressing maternal healthThrough a provision in the 2021 U.S. American Rescue Plan Act, the federal government offered states the option to extend postpartum Medicaid benefits to a full year.According to KFF, since April 2022, the Centers for Medicare and Medicaid Services has already approved programs in 35 states across the country, including fellow Republican-led states like Alabama and Tennessee.A report published in 2022 by the Missouri Department of Health and Senior Services found that an average of 61 Missourians each year died while pregnant or within one year of giving birth. The report studied maternal deaths from 2017-19.Furthermore, the rate of mothers on Medicaid dying during or within one year of pregnancy was more than eight times higher than those with private health insurance.

Brian Munoz

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St. Louis Public RadioMary Maschmeier, right, the founder and president of the St. Charles-based Defenders of the Unborn anti-abortion roup, rallies in celebration of a U.S. Supreme Court decision overturning Roe v. Wade, while Ritika Chand-Berfeld, of Webster Groves, protests the decision in June 2022 during an anti-abortion rally outside of Planned Parenthood’s clinic in the Central West End.

Republicans point to interest in family careBoth Democrats and Republicans played their part in getting the bill through both chambers. But opinions on why the legislation passed the extension can differ depending on political party as well as stance on abortion.Missouri Republicans spoke on their commitment to decrease maternal mortality in the state during the legislative session, including both Parson and Senate President Pro-Temp Caleb Rowden, R-Columbia.Rowden said Republicans should redefine what it means to be “pro-life,” which includes supporting policies like the coverage extension.

Brian Munoz

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St. Louis PublicSen. Elaine Gannon, R-De Soto, speaks about Sen. Karla May, D- St. Louis, on last January during the first day of the legislative session at the Missouri State Capitol in Jefferson City. Gannon sponsored the post-partum Medicaid extension bill in the Missouri Senate.

Sen. Elaine Gannon, R-De Soto, who sponsored the bill, said she fielded questions from some of her more conservative colleagues about the cost of more postpartum care.“We are talking about saving lives here. Therefore, in my opinion, if it increases the cost of spending, then it’s for one of the best causes,” Gannon said.Sam Lee with anti-abortion group Campaign Life Missouri said he was ecstatic to see lawmakers pass the bill this session and believes the bipartisan support shows just how popular that idea was.“I think everybody wants to help pregnant and new moms,” Lee said. “I think that just sort of a natural inclination, regardless of your politics, whether you’re on the left or on the right.”Lee said he doesn’t believe the passage of the bill had anything to do with the Dobbs decision that overturned abortion rights in June 2022. He said there was a desire to pass a Medicaid postpartum care extension the session before Dobbs even occurred.“I don’t think Dobbs had anything to do with timing. But it is clear that the public does want lawmakers to provide support for pregnant and new moms and their children. And this is one of those components,” Lee said.

Brian Munoz

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St. Louis Public RadioHouse Minority Leader Rep. Crystal Quade, D-Springfield, speaks to the media last January during the first day of the legislative session at the Missouri State Capitol in Jefferson City.

Democrats say Republican support for bill is tied to abortionSome Democrats and abortion-rights activists say it’s not a coincidence that the legislature was able to pass this bill the first session after almost all abortion became illegal in Missouri.House Minority Leader Crystal Quade, D-Springfield, who announced Monday her campaign for governor, is one of those Democrats. She thinks the Republicans are trying to protect their public image after pushing for the abortion ban.“I believe Republican lawmakers decided to start filing these bills that are pro-life bills that are pro-family and passing them and I’m grateful that these bills are moving, but I definitely think it is because of that backlash,” Quade said.Maggie Olivia with the abortion-rights group Abortion Action Missouri agrees. She said she believes this was a media opportunity for those who are anti-abortion.“The anti-abortion folks who set themselves up as supporters of this policy were really only doing so in order to save political face and falsely signal compassion, while they are continuing to further attack access to care for pregnant folks across the state,” Olivia said.

Brian Munoz

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St. Louis Public RadioXavier Becerra, U.S. Secretary of Health and Human Services, speaks to the media about the 1-year anniversary of the Dobbs decision, which overturned the constitutional right to access an abortion last June at the Planned Parenthood’s clinic in the Central West End.

The national reframing trendAnita Manion, a political science professor at the University of Missouri-St. Louis, said this has long been an issue that Democrats have expressed concerns over, and that Republicans in Missouri are following a national trend on reframing what it means to support families.That includes supporting an extension of postpartum Medicaid services, even in Missouri where Medicaid expansion only occurred after citizens voted to add it to the state constitution. Manion also believes the overturning of Roe v. Wade played a role.“We’ve also seen a pivot among a lot of conservative legislators here and nationally to try to find ways to say, ‘We support women and children after birth,’ and not just sort of as some people are seeing it, forcing women to carry pregnancies or forcing pregnant people to have children,” Manion said.Manion also said states passing these policies could be motivated by political parties wanting to capture the vote of suburban women.“We’ve seen them go after those women, whether it’s school issues, with vaccines, with staying in school, with masking in school, and we’ve seen it with the Dobbs decision,” Manion said. “And so I think in some ways, this is a continuation of trying to get those voters and motivate them.”In June, U.S. Secretary of Health and Human Services Xavier Becerra visited Missouri to mark the one-year anniversary of the overturning of Roe v. Wade. He said while abortion access should be restored, he did not believe it is connected to the extension of Medicaid coverage for new moms popping up across the country.“We’ve needed to provide better health care services for women and their babies for a long time. And making sure that a woman can access maternal health care under Medicaid for more than 60 days, which was previous law, but now get it for full 365 days is absolutely indispensable and we are appreciative of all the states that are joining in the effort to expand maternal health care for all women,” Becerra said.

Brian Munoz

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St. Louis Public RadioKayla O’Neal, right, 28, holds Caine, her 2-week-old baby, as grandmother Tracey O’Neal, 55, holds Cauri, Kayla’s 2-week-old twin, last January at her home in St. Peters.

A good startDr. Ebony Carter sees this extension as a game changer for her high-risk patients.“I actually think that it’s now going to challenge us as physicians and as a larger medical system to do better to do better by our patients,” Carter said.For St. Louis mom Sharron Prather, her own experiences led her to help others who are going through what she went through. Prather currently works as a social worker for Nurses for Newborns.She said the clients she works with are excited about the new law.“I have repeat moms and so they’re just like, ‘Finally, like, this is what I’m talking about.’ I was like, ‘Hey, I’m like, I’m out there. I’m trying to advocate for it.’ So I was very excited to share that with them,” Prather said.Prather said having health insurance for a year postpartum is going to give new moms more time to learn what their health care options are.“They have time to actually look into it and they actually explore some of those benefits. I think a year at least, to start, it’s not like my goal, but I think it’s at least a start,” Prather said.

Brian Munoz

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St. Louis Public RadioSharron Prather, 42, of Hazelwood, speaks about postpartum healthcare last Thursday at St. Ferdinand Park in Florissant.

As to what also could be done, both Carter and Prather have ideas on improving health outcomes for moms.“You also have to think about the social determinants of health like what are the resources that we have, to be educated and have good housing and have access to healthy foods. So, there’s so much more and beyond the social determinants of health, those are not distributed fairly or equally among our society, and why is that? Discrimination and racism and oppression. So, it goes so much deeper,” Carter said.Carter believes stronger funding for mental health support services and providing paid parental leave are important.“I think that we don’t do a great job of supporting new families with the economic hardship that comes with it, especially if you were already poor, and now you’re losing time at work with parental leave,” Carter said.One of Prather’s goals is to extend postpartum Medicaid coverage to at least three years. She said that could improve the continuity of care between the patients and their doctor.“I feel like some of the doctors in some of the clinics will take their patients more seriously. Sometimes when they see Medicaid, their treatment is different than if they have a private insurance.” Prather said. “I feel like the stigma will be, I don’t want to say erased, but better, it’ll be better.”

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Poll: Support for Missouri abortion rights amendment growing

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A proposed constitutional amendment legalizing abortion in Missouri received support from more than half of respondents in a new poll from St. Louis University and YouGov.That’s a boost from a poll earlier this year, which could mean what’s known as Amendment 3 is in a solid position to pass in November.SLU/YouGov’s poll of 900 likely Missouri voters from Aug. 8-16 found that 52% of respondents would vote for Amendment 3, which would place constitutional protections for abortion up to fetal viability. Thirty-four percent would vote against the measure, while 14% aren’t sure.By comparison, the SLU/YouGov poll from February found that 44% of voters would back the abortion legalization amendment.St. Louis University political science professor Steven Rogers said 32% of Republicans and 53% of independents would vote for the amendment. That’s in addition to nearly 80% of Democratic respondents who would approve the measure. In the previous poll, 24% of Republicans supported the amendment.Rogers noted that neither Amendment 3 nor a separate ballot item raising the state’s minimum wage is helping Democratic candidates. GOP contenders for U.S. Senate, governor, lieutenant governor, treasurer and secretary of state all hold comfortable leads.“We are seeing this kind of crossover voting, a little bit, where there are voters who are basically saying, ‘I am going to the polls and I’m going to support a Republican candidate, but I’m also going to go to the polls and then I’m also going to try to expand abortion access and then raise the minimum wage,’” Rogers said.Republican gubernatorial nominee Mike Kehoe has a 51%-41% lead over Democrat Crystal Quade. And U.S. Sen. Josh Hawley is leading Democrat Lucas Kunce by 53% to 42%. Some GOP candidates for attorney general, secretary of state and treasurer have even larger leads over their Democratic rivals.

Brian Munoz

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St. Louis Public RadioHundreds of demonstrators pack into a parking lot at Planned Parenthood of St. Louis and Southwest Missouri on June 24, 2022, during a demonstration following the Supreme Court’s reversal of a case that guaranteed the constitutional right to an abortion.

One of the biggest challenges for foes of Amendment 3 could be financial.Typically, Missouri ballot initiatives with well-funded and well-organized campaigns have a better chance of passing — especially if the opposition is underfunded and disorganized. Since the end of July, the campaign committee formed to pass Amendment 3 received more than $3 million in donations of $5,000 or more.That money could be used for television advertisements to improve the proposal’s standing further, Rogers said, as well as point out that Missouri’s current abortion ban doesn’t allow the procedure in the case of rape or incest.“Meanwhile, the anti side won’t have those resources to kind of try to make that counter argument as strongly, and they don’t have public opinion as strongly on their side,” Rogers said.There is precedent of a well-funded initiative almost failing due to opposition from socially conservative voters.In 2006, a measure providing constitutional protections for embryonic stem cell research nearly failed — even though a campaign committee aimed at passing it had a commanding financial advantage.Former state Sen. Bob Onder was part of the opposition campaign to that measure. He said earlier this month it is possible to create a similar dynamic in 2024 against Amendment 3, if social conservatives who oppose abortion rights can band together.“This is not about reproductive rights or care for miscarriages or IVF or anything else,” said Onder, the GOP nominee for Missouri’s 3rd Congressional District seat. “Missourians will learn that out-of-state special interests and dark money from out of state is lying to them and they will reject this amendment.”Quade said earlier this month that Missourians of all political ideologies are ready to roll back the state’s abortion ban.“Regardless of political party, we hear from folks who are tired of politicians being in their doctor’s offices,” Quade said. “They want politicians to mind their own business. So this is going to excite folks all across the political spectrum.”

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Democrat Mark Osmack makes his case for Missouri treasurer

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Mark Osmack has been out of the electoral fray for awhile, but he never completely abandoned his passion for Missouri politics.Osmack, a Valley Park native and U.S. Army veteran, previously ran for Missouri’s 2nd Congressional District seat and for state Senate. Now he’s the Democratic nominee for state treasurer after receiving a phone call from Missouri Democratic Party Chairman Russ Carnahan asking him to run.“There’s a lot of decision making and processing and evaluation that goes into it, which is something I am very passionate and interested in,” Osmack said this week on an episode of Politically Speaking.Osmack is squaring off against state Treasurer Vivek Malek, who was able to easily win a crowded GOP primary against several veteran lawmakers including House Budget Chairman Cody Smith and state Sen. Andrew Koenig.While Malek was able to attract big donations to his political action committee and pour his own money into the campaign, Osmack isn’t worried that he won’t be able to compete in November. Since Malek was appointed to his post, Osmack contends he hasn’t proven that he’s a formidable opponent in a general election.“His actions and his decision making so far in his roughly two year tenure in that office have been questionable,” Osmack said.Among other things, Osmack was critical of Malek for placing unclaimed property notices on video gaming machines which are usually found in gas stations or convenience stores. The legality of the machines has been questioned for some time.As Malek explained on his own episode of Politically Speaking, he wanted to make sure the unclaimed property program was as widely advertised as possible. But he acknowledged it was a mistake to put the decals close to the machines and ultimately decided to remove them.Osmack said: “This doesn’t even pass the common sense sniff test of, ‘Hey, should I put state stickers claiming you might have a billion dollars on a gambling machine that is not registered with the state of Missouri?’ If we’re gonna give kudos for him acknowledging the wrong thing, it never should have been done in the first place.”Osmack’s platform includes supporting programs providing school meals using Missouri agriculture products and making child care more accessible for the working class.He said the fact that Missouri has such a large surplus shows that it’s possible to create programs to make child care within reach for parents.“It is quite audacious for [Republicans] to brag about $8 billion, with a B, dollars in state surplus, while we offer next to no social services to include pre-K, daycare, or child care,” Osmack said.Here’s are some other topics Osmack discussed on the show:How he would handle managing the state’s pension systems and approving low-income housing tax credits. The state treasurer’s office is on boards overseeing both of those programs.Malek’s decision to cut off investments from Chinese companies. Osmack said that Missouri needs to be cautious about abandoning China as a business partner, especially since they’re a major consumer of the state’s agriculture products. “There’s a way to make this work where we are not supporting communist nations to the detriment of the United States or our allies, while also maintaining strong economic ties that benefit Missouri farmers,” he said.What it was like to witness the skirmish at the Missouri State Fair between U.S. Sen. Josh Hawley and Democratic challenger Lucas Kunce.Whether Kunce can get the support of influential groups like the Democratic Senatorial Campaign Committee, which often channels money and staff to states with competitive Senate elections.

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As Illinois receives praise for its cannabis equity efforts, stakeholders work on system’s flaws

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Medical marijuana patients can now purchase cannabis grown by small businesses as part of their allotment, Illinois’ top cannabis regulator said, but smaller, newly licensed cannabis growers are still seeking greater access to the state’s medical marijuana customers.Illinois legalized medicinal marijuana beginning in 2014, then legalized it for recreational use in 2020. While the 2020 law legalized cannabis use for any adult age 21 or older, it did not expand licensing for medical dispensaries.Patients can purchase marijuana as part of the medical cannabis program at dual-purpose dispensaries, which are licensed to serve both medical and recreational customers. But dual-purpose dispensaries are greatly outnumbered by dispensaries only licensed to sell recreationally, and there are no medical-only dispensaries in the state.As another part of the adult-use legalization law, lawmakers created a “craft grow” license category that was designed to give more opportunities to Illinoisans hoping to legally grow and sell marijuana. The smaller-scale grow operations were part of the 2020 law’s efforts to diversify the cannabis industry in Illinois.Prior to that, all cultivation centers in Illinois were large-scale operations dominated by large multi-state operators. The existing cultivators, mostly in operation since 2014, were allowed to grow recreational cannabis beginning in 2019.Until recently, dual-purpose dispensaries have been unsure as to whether craft-grown products, made by social equity licensees — those who have lived in a disproportionately impacted area or have been historically impacted by the war on drugs — can be sold medicinally as part of a patient’s medical allotment.Erin Johnson, the state’s cannabis regulation oversight officer, told Capitol News Illinois last month that her office has “been telling dispensaries, as they have been asking us” they can now sell craft-grown products to medical patients.“There was just a track and trace issue on our end, but never anything statutorily,” she said.

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Capitol News IllinoisThe graphic shows how cannabis grown in Illinois gets from cultivation centers to customers.

No notice has been posted, but Johnson’s verbal guidance comes almost two years after the first craft grow business went online in Illinois.It allows roughly 150,000 medical patients, who dispensary owners say are the most consistent purchasers of marijuana, to buy products made by social equity businesses without paying recreational taxes. However — even as more dispensaries open — the number available to medical patients has not increased since 2018, something the Cannabis Regulation Oversight Office “desperately” wants to see changed. Johnson said Illinois is a limited license state, meaning “there are caps on everything” to help control the relatively new market.Berwyn Thompkins, who operates two cannabis businesses, said the rules limited options for patients and small businesses.“It’s about access,” Thompkins said. “Why wouldn’t we want all the patients — which the (adult-use) program was initially built around — why wouldn’t we want them to have access? They should have access to any dispensary.”Customers with a medical marijuana card pay a 1% tax on all marijuana products, whereas recreational customers pay retail taxes between roughly 20 and 40% on a given cannabis product, when accounting for local taxes.While Illinois has received praise for its equity-focused cannabis law, including through an independent study that showed more people of color own cannabis licenses than in any other state, some industry operators say they’ve experienced many unnecessary hurdles getting their businesses up and running.The state, in fact, announced last month that it had opened its 100th social equity dispensary.But Steve Olson, purchasing manager at a pair of dispensaries (including one dual-purpose dispensary) near Rockford, said small specialty license holders have been left in the lurch since the first craft grower opened in October 2022.“You would think that this would be something they’re (the government) trying to help out these social equity companies with, but they’re putting handcuffs on them in so many different spots,” he said. “One of them being this medical thing.”Olson said he contacted state agencies, including the Department of Financial and Professional Regulation, months ago about whether craft products can be sold to medical patients at their retail tax rate, but only heard one response: “They all say it was an oversight.”This potentially hurt social equity companies because they sell wholesale to dispensaries and may have been missing out on a consistent customer base through those medical dispensaries.Olson said the state’s attempts to provide licensees with a path to a successful business over the years, such as with corrective lotteries that granted more social equity licenses, have come up short.“It’s like they almost set up the social equity thing to fail so the big guys could come in and swoop up all these licenses,” Olson said. “I hate to feel like that but, if you look at it, it’s pretty black and white.”Olson said craft companies benefit from any type of retail sale.“If we sell it to medical patients or not, it’s a matter of, ‘Are we collecting the proper taxes?’ That’s all it is,” he said.State revenue from cannabis taxes, licensing costs and other fees goes into the Cannabis Regulation Fund, which is used to fund a host of programs, including cannabis offense expungement, the general revenue fund, and the R3 campaign aiming to uplift disinvested communities.For fiscal year 2024, nearly $256 million was paid out from Cannabis Regulation Fund for related initiatives, which includes almost $89 million transferred to the state’s general revenue fund and more than $20 million distributed to local governments, according to the Illinois Department of Revenue.Medical access still limitedThe state’s 55 medical dispensaries that predate the 2020 legalization law, mostly owned by publicly traded multistate operators that had been operating in Illinois since 2014 under the state’s medical marijuana program, were automatically granted a right to licenses to sell recreationally in January 2020. That gave them a dual-purpose license that no new entrants into the market can receive under current law.Since expanding their clientele in 2020, Illinois dispensaries have sold more than $6 billion worth of cannabis products through recreational transactions alone.Nearly two-thirds of dispensaries licensed to sell to medical patients are in the northeast counties of Cook, DuPage, Kane, Lake and Will. Dual-purpose dispensaries only represent about 20 percent of the state’s dispensaries.While the state began offering recreational dispensary licenses since the adult-use legalization law passed, it has not granted a new medical dispensary license since 2018. That has allowed the established players to continue to corner the market on the state’s nearly 150,000 medical marijuana patients.But social equity licensees and advocates say there are more ways to level the playing field, including expanding access to medical sales.Johnson, who became the state’s top cannabis regulator in late 2022, expressed hope for movement during the fall veto session on House Bill 2911, which would expand medical access to all Illinois dispensaries.“We would like every single dispensary in Illinois to be able to serve medical patients,” Johnson said. “It’s something that medical patients have been asking for, for years.”Johnson said the bill would benefit patients and small businesses.“It’s something we desperately want to happen as a state system, because we want to make sure that medical patients are able to easily access what they need,” she said. “We also think it’s good for our social equity dispensaries, as they’re opening, to be able to serve medical patients.”Rep. Bob Morgan, D-Deerfield, who was the first statewide project coordinator for Illinois’ medical cannabis program prior to joining the legislature, wrote in an email to Capitol News Illinois that the state needs to be doing more for its patients.“Illinois is failing the state’s 150,000 medical cannabis patients with debilitating conditions. Too many are still denied the patient protections they deserve, including access to their medicine,” Morgan wrote, adding he would continue to work with stakeholders on further legislation.Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of newspapers, radio and TV stations statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and Southern Illinois Editorial Association.

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