Robin Abcarian, Los Angeles Times on Published in Op Eds
I had a difficult time reading the gut-wrenching accounts from the parents of gay children who are part of the Supreme Court case about conversion therapy bans and freedom of speech.
All claim their family relationships were seriously damaged by the widely discredited practice, and that their children were permanently scarred or even driven to suicide.
The case, Chiles vs. Salazar, arose from a 2019 Colorado law that outlaws conversion therapy, whose practitioners say they can change a minor’s sexual orientation or gender identity to align with heterosexual and cisgender norms. The therapy is considered harmful and ineffective by mainstream medical and mental health organizations.
At least two dozen other states have similar laws on the books, all of them good-faith attempts to prevent the lasting harm that can result when a young person is told not just that they can change who they are, but that they should change because God wants them to. The laws were inspired by the horrific experiences of gay and transgender youths whose families and churches tried to change them.
The case was brought by Kayley Chiles, a licensed counselor and practicing Christian who believes, according to her attorneys, that “people flourish when they live consistently with God’s design, including their biological sex.”
Colorado, incidentally, has never charged Chiles or anyone else in connection with the 2019 law.
Chiles is represented by the Alliance Defending Freedom, a conservative Christian law firm known for its challenges to gay and transgender rights, including one brought to the Supreme Court in 2023 by Christian web designer Lorie Smith, who did not want to be forced to create a site for a gay wedding, even though no gay couple had ever approached her to do so. The Court’s conservative majority ruled in Smith’s favor. All three liberals dissented.
As for conversion therapy, counselors often encourage clients to blame their LGBTQ+ identities on trauma, abuse or their dysfunctional families. (If it can be changed, it can’t possibly be innate, right?)
In oral arguments, it appeared the conservative justices were inclined to accept Chiles’ claim that Colorado’s ban on conversion therapy amounts to viewpoint discrimination, a violation of the 1st Amendment’s free speech guarantees. The liberal minority was more skeptical.
But proponents of the bans say there is a big difference between speech and conduct. They argue that a therapist’s attempt to change a minor’s sexual orientation or gender identity amounts to conduct, and can rightfully be regulated by states, which, after all, lawfully impose conditions on all sorts of licensed professionals. (The bans, by the way, do not apply to ministers or unlicensed practitioners, and are generally not applicable to adults.)
Each competing brief whipsawed my emotions. The 1st Amendment is sacred in so many ways, and yet states have a critical interest in protecting the health and welfare of children. How to find a balance?
After reading the brief submitted by a group of 1st Amendment scholars, I was convinced the Colorado law should be ruled unconstitutional. As they wrote of Chiles, she doesn’t hook her clients to electrodes or give them hormones, as some practitioners of conversion therapy have done in the past. “The only thing she does is talk, and listen.”
Then I turned to the parents’ briefs.
Linda Robertson, an evangelical Christian mother of four, wrote that she was terrified when her 12-year-old son Ryan confided to her in 2001 that he was gay. “Crippling fear consumed me — it stole both my appetite and my sleep. My beautiful boy was in danger and I had to do everything possible to save him.”
Robertson’s search led her to “therapists, authors and entire organizations dedicated to helping kids like Ryan resist temptation and instead become who God intended them to be.”
Ryan was angry at first, then realized, his mother wrote, that “he didn’t want to end up in hell, or be disapproved of by his parents and his church family.” Their quest to make Ryan straight led them to “fervent prayer, scripture memorization, adjustments in our parenting strategies, conversion therapy based books, audio and video recordings and live conferences with titles like, ‘You Don’t Have to be Gay’ and ‘How to Prevent Homosexuality.’ ”
They also attended a conference put on by Exodus International, the “ex-gay” group that folded in 2013 after its former founder repudiated the group’s mission and proclaimed that gay people are loved by God.
After six years, Ryan was in despair. “He still didn’t feel attracted to girls; all he felt was completely alone, abandoned and needed the pain to stop,” his mother wrote. Worse, he felt that God would never accept him or love him. Ryan died at age 20 of a drug overdose after multiple suicide attempts.
As anyone with an ounce of common sense or compassion knows, such “therapy” is a recipe for shame, anguish and failure.
Yes, there are kids who question their sexuality, their gender identity or both, and they deserve to discuss their internal conflicts with competent mental health professionals. I can easily imagine a scenario where a teenager tells a therapist they think they’re gay or trans but don’t want to be.
The job of a therapist is to guide them through their confusion to self-acceptance, not tell them what the Bible says they should be.
If recent rulings are any guide, the Supreme Court is likely to overturn the Colorado conversion therapy ban.
This would mean, in essence, that a therapist has the right to inflict harm on a struggling child in the name of free speech.
There is a video at the link below showing the restraint. Because of being restrained during abuse as a child I can not stand anything pinning my legs or arms down. When I had my left hip done the doctor required patients to be strapped into an immobilizing device. When I woke up in the hospital with it on I totally lost my shit and they had to remove it. But the doctor wouldn’t allow anyone to lay flat or sleep without it. So for weeks I slept upright in Ron’s recliner. There is no need for a torture device such as this used by ICE. It is designed to be punitive and cause people harm. Hugs
The Nigerian man described being roused with other detainees in September in the middle of the night. U.S. Immigration and Customs Enforcement officers clasped shackles on their hands and feet, he said, and told them they were being sent to Ghana, even though none of them was from there.
When they asked to speak to their attorney, he said, the officers refused and straitjacketed the already-shackled men in full-body restraint suits called the WRAP, then loaded them onto a plane for the 16-hour-flight to West Africa.
Referred to as “the burrito” or “the bag,” the WRAP has become a harrowing part of deportations for some immigrants.
“It was just like a kidnapping,” the Nigerian man, who’s part of a federal lawsuit, told The Associated Press in an interview from the detainment camp in which he and other deportees were being held in Ghana. Like others placed in the restraints interviewed by the AP, he spoke on the condition of anonymity for fear of reprisals.
The AP identified multiple examples of ICE using the black-and-yellow full-body restraint device, the WRAP, in deportations. Its use was described to the AP by five people who said they were restrained in the device, sometimes for hours, on ICE deportation flights dating to 2020. And witnesses and family members in four countries told the AP about its use on at least seven other people this year.
The AP found ICE has used the device despite internal concerns voiced in a 2023 report by the civil rights division of its parent agency, the U.S. Department of Homeland Security, in part due to reports of deaths involving use of the WRAP by local law enforcement. And the AP has identified a dozen fatal cases in the last decade where local police or jailers around the U.S. used the WRAP and autopsies determined “restraint” played a role in the death.
The WRAP is the subject of a growing number of federal lawsuits likening incorrect usage of the device to punishment and even torture, whether used in a jail or by immigration authorities during international flights. Among advocates’ concerns is that ICE is not tracking the WRAP’s use as required by federal law when officers use force.
DHS has paid Safe Restraints Inc., the WRAP’s California-based maker, $268,523 since it started purchasing the devices in late 2015 during the Obama administration. Government purchasing records show the two Trump administrations have been responsible for about 91% of that spending. ICE would not provide AP with records documenting its use of the WRAP despite multiple requests, and it’s not clear how frequently it has been used in the current and prior administrations.
The WRAP’s manufacturer says it intended the device to be a lifesaver for law enforcement confronting erratic people who were physically attacking officers or harming themselves.
But ICE officials have a much lower threshold for deploying the WRAP than the manufacturer advises, the AP found. Detainees interviewed by the AP said ICE officers used the restraints on them after they had been shackled. They said this was done to intimidate or punish them for asking to speak to their attorneys or expressing fear at being deported, often to places they fled due to violence and torture.
The West African deportee described a terrifying, hourslong experience that left his legs swollen to the point where he walked with a limp.
“They bundled me and my colleagues,” he said, “tied us up in a straitjacket.”
ICE and DHS would not answer detailed questions from the AP and refused a request for the government’s policy for when and how to use the WRAP.
“The use of restraints on detainees during deportation flights has been long standing, standard ICE protocol and an essential measure to ensure the safety and well-being of both detainees and the officers/agents accompanying them,” Tricia McLaughlin, DHS’ spokesperson, said in an email to AP. “Our practices align with those followed by other relevant authorities and is fully in line with established legal standards.”
The agency would not specify those authorities or describe its practices.
“The use of these devices is inhumane and incompatible with our nation’s fundamental values,” said Noah Baron, an attorney for the West African deportees.
Charles Hammond, CEO of Safe Restraints Inc., said his company has made a modified version of the device for ICE, with changes meant to allow people to be kept in it during flights and long bus trips.
ICE’s version includes a ring on the front of the suit that allows a subject’s cuffed hands to be attached while still allowing for limited use to eat and drink, he said. In addition, the ICE version has “soft elbow cuffs,” Hammond said, which connect in the back so a person can move for proper circulation but can’t flip an elbow out to hit someone.
This photo provided by Safe Restraints Inc., in October 2025, shows a custom version of the WRAP restraining equipment made for the U.S. Immigration and Customs Enforcement agency. (Safe Restraints via AP)
This photo provided by Safe Restraints Inc., in October 2025, shows a custom ICE version of the WRAP with soft elbow cuffs that keep the arms against the body but allow relatively free use of the hands. (Safe Restraints via AP)
An AP reporter recounted for Hammond some of the allegations made by people who had been placed in the WRAP for long flights. All of those interviewed by AP said their hands and feet were already restrained by chains. All denied fighting with officers, saying they were either crying or pleading against their deportation to countries they deemed dangerous.
Hammond said that, if true that some people were not being violent and simply protesting verbally, putting them in the WRAP could be improper use.
“That’s not the purpose of the WRAP. If (the deportee) is a current or potential risk to themselves, to officers, to staff, to the plane, restraints are justified. If it’s not, then restraints aren’t.”
‘Please help me’
Juan Antonio Pineda said he was put into “a bag” in late September and driven by immigration officers to the Mexico border. It was black with yellow stripes and had straps that immobilized his body and connected over his shoulders — the WRAP.
Pineda, who is from El Salvador, was in the U.S. legally, he said in a video from an ICE detention center in Arizona. On Sept. 3, he went to an appointment in Maryland to get permission for another year, his wife, Xiomara Ochoa, said in an interview from El Salvador. Instead, he was detained by ICE and told he’d be deported to Mexico, but the documents he was shown had someone else’s name, he said. Even so, he was sent to the Florence Service Processing Center detention facility in Arizona.
In this image from video provided by Xiomara Ochoa, Juan Antonio Pineda shows a cast for his arm as he speaks during an interview from the ICE detention center in Florence, Ariz., on Sept. 29, 2025 .(Xiomara Ochoa via AP)
Early morning on Wednesday, Sept. 24, he said officers tied his hands and legs, placed him into the “bag” and drove him four hours to the border. When he refused to sign the deportation papers, Pineda alleges officers broke his right arm and gave him a black eye before driving him back another four hours in the “bag.” The AP was unable to independently confirm how he was injured. Pineda’s video shows him with a cast on his arm and bruising on his face.
The next day, Thursday, Sept. 25, they tied him up again, put him in the bag and drove him to the border, where Mexican immigration officials turned him away, he said.
“Eight hours there and back and they don’t give me food or water or anything,” he said in the video, which his wife shared with the AP. “Please help me.”
He was ultimately deported to Mexico, Ochoa said.
ICE did not respond to multiple requests for comment from the AP regarding Pineda’s case.
In addition to the Nigerian man flown to Ghana, four others interviewed by AP said they were placed in the WRAP and carried onto deportation flights since the first Trump administration.
As U.S. immigration officials move aggressively to meet the president’s deportation goals, advocates and attorneys for immigrants are echoing the concerns of the government’s own civil rights inquiry that ICE officers aren’t trained on how to use the restraints.
“This should be a last resort type of restraint after they’ve already tried other things,” said Fatma Marouf, a Texas A&M law professor who has sued ICE over its use of the device. “Just being bound up like that can inflict a lot of psychological harm.”
Some deportees said they were left in the WRAP for an entire fight. A lawsuit filed on behalf of the Nigerian man and four others currently detained in Dema Camp, Ghana, included the allegation from one that ICE left the restraint suit on him for 16 hours, only once undoing the lower part so he could use the bathroom.
“No one should be put into a WRAP. I don’t even think they strap animals like that,” recalled a man who said he suffered a concussion and dislocated jaw being placed into the device in 2023 before a deportation flight to Cape Verde, an African island nation. AP’s review of his medical records confirmed he suffered those injuries in 2023.
“It was the most painful thing I’ve been through,” said the man, adding he was restrained most of the 10-hour flight. “Forget the assault, forget the broken jaw. Just the WRAP itself was hurtful.”
Also, the man said, the metal ring his cuffed hands were attached to — one of the ICE modifications to the WRAP designed to increase comfort — injured him. “When they slammed me face forward on the floor, that metal ring dug into my chest causing me bruising and pain which was part of my injuries that I complained about.”
ICE’s current use of the WRAP comes amid an unprecedented wave of masked federal immigration officers grabbing suspected immigrants off the street, and mounting accusations that the Trump administration has dehumanized them, including by subjecting them to cruel and unusual detention conditions.
ICE’s use of the WRAP has continued despite a 2023 report by DHS’s Office for Civil Rights and Civil Liberties, or CRCL, that raised serious concerns over the lack of policies governing its use.
ICE agreed with the internal findings on some points, a then-DHS official involved in the review said, but challenged the notion that the WRAP should be classified as a “four-point restraint,” a designation that would place more limitations on its use. The person spoke on condition of anonymity because they weren’t authorized to discuss the inquiry.
DHS largely dismantled the office that produced the 2023 report earlier this year amid widespread government firings, calling it a roadblock to enforcement operations.
“Without changes to the current training, and the lack of policy, CRCL has serious concerns about ICE’s continued use of the WRAP,” wrote the report’s authors, who cited a news article mentioning lawsuits claiming the device had led to deaths.
Use by police and in jails
Last year police officers in Virginia Beach, Virginia, placed Rolin Hill in the WRAP, saying he was being combative during an arrest at a convenience store. The officers left Hill in the device when they dropped him at the jail. Video from the jail shows deputies punching the WRAP-immobilized Hill in the head and back. Hill died in a hospital, and while the WRAP’s exact role is unknown, Hill’s death was ruled a homicide by “positional and mechanical asphyxia due to restraint with neck and torso compression.” Three of the deputies are now charged with his murder, and five were removed from their jobs.
Also last year, in Missouri, prosecutors charged five jailers in the death of Othel Moore Jr., who according to an autopsy asphyxiated in the WRAP. Jailhouse footage showed Moore, who’d also been sprayed with tear gas and placed in a “spit mask” covering his face, repeatedly told officers he couldn’t breathe.
In this image from surveillance video provided by Jefferson City Correctional Center, jailers examine Othel Moore Jr., at the Jefferson City Correctional Center in Jefferson City, Mo., on Dec. 8, 2023, who according to an autopsy asphyxiated in the WRAP restraint. (Jefferson City Correctional Center via AP)
While Hammond insists the WRAP has never been determined as the cause of death when used properly, the AP identified 43 times in which the WRAP was used by police or correctional officers in a case in which someone died. In 12 of those cases the official autopsy determined that “restraint” played some role in the death.
It was often impossible to determine the exact role the WRAP may have played, as deaths often involved the use of other potentially dangerous force on people who in several cases were high on methamphetamine.
The WRAP first appeared in law enforcement in the late 1990s, presented as an alternative to tying a subject’s hands and feet together in a practice known as “hog-tying.” It first found widespread use in California jails and today is used by more than 1,800 departments and facilities around the country, according to the manufacturer, which says it has sold more than 10,000 devices.
Many of these cases have drawn little media attention, such as the 2020 case of Alberto Pena, who was jailed on a misdemeanor criminal mischief charge after getting drunk and damaging the walls and doors at his parents’ home outside Rio Grande City, Texas. The 30-year-old became erratic on the way to the Starr County Jail, beating his own head against the inside of the patrol unit and, later, the wall of his cell.
Deputies placed Pena in the WRAP for more than two hours, where he repeatedly cried out for help and complained he could not breathe. But he was left unattended in the device for significant periods of time, court records show, and no medical attention was provided for his self-inflicted head injuries.
An autopsy ruled Pena’s death “accidental,” but a forensic pathologist hired by the family attributed Pena’s death in part to the WRAP’s “prolonged restraint” and said it “could have been averted” with proper medical care.
“The WRAP should have never been used in this situation. It was a medical emergency and he should have been taken to the hospital,” said Natasha Powers-Marakis, a former police officer and use of force expert who reviewed the case on behalf of Pena’s family as part of their wrongful death lawsuit against the county and officers who placed him in the device. The arresting officers had been told Pena suffered from bipolar disorder.
The Starr County Sheriff’s Office has denied wrongdoing and maintained Pena did not require medical care. Robert Drinkard, an attorney for the county, told AP the use of the WRAP “was neither improper nor caused Mr. Pena’s tragic death.” He added that each deputy involved in placing Pena in the WRAP had been trained in its application.
A federal judge recently dismissed the Pena family’s lawsuit, ruling the deputies were shielded from liability.
‘Carrying me like a corpse’
In the context of an ICE deportation flight, the use of restraints like the WRAP can be justified, Hammond, the manufacturer’s CEO, argues.
ICE officers have to ensure that they secure anyone who could pose a fight risk on a long flight, he said. Given the high stakes of a violent confrontation on an airplane, Hammond believes cases like those described to the AP can warrant the WRAP’s use, even if the person is already in chains.
However, properly trained agents are supposed to loosen the straps and allow enough movement so the subject can eat and drink, as well as use the bathroom.
“With the WRAP, when it is used properly, it’s a shorter fight, which is good for everybody. It prioritizes breathing, which is good for everybody. And you have no more fight and can provide medical care or mental health care or de-escalation efforts,” Hammond said.
Those placed in one of Hammond’s restraint suits, however, recount the experience as traumatic.
One of these people was first put into five-point shackles when he became dizzy and tripped while ascending the stairs to board the ICE flight to Cameroon in November 2020. The officer mistook his stumbling as resistance, he said. Immediately, camouflage-clad ICE officers quickly pushed him to the tarmac and onto a WRAP device, he said.
Soon, he felt the straps cinching around his legs and upper body.
“They bundled me like a log of wood from all the sides and they were just carrying me like a corpse,” he said.
Another man interviewed by the AP said ICE officers put him in the WRAP after he initially resisted efforts to move him onto a deportation flight in Alexandria, Louisiana, in 2020. He’d fled political violence and persecution in his native Cameroon, and was afraid to go back. He said officers took him out of his cell in front of the other detainees and put him in the WRAP, leaving him for hours in view of the others as a warning to them not to speak up.
“I told him ‘I can’t breathe,’” the man said. “He responded, ’I don’t care, I’m doing my job.’”
___
Dearen and Pineda reported from Los Angeles and Mustian reported from New York. AP journalists Ope Adetayo in Abuja, Ghana, Obed Lamy in Indianapolis and Ryan J. Foley in Iowa City, Iowa, contributed to this report. Dan Lawton also contributed.
ICE is a totally out of control rogue government agency that is simply lawless thugs. This was a civilian in medical distress in the ambulance. In a worse medical emergency the person could have died. The person was not in custody and a citizen but ICE demanded to be allowed to control them. Wake up people we have crossed all the lines. We barely have a functioning democracy. We all need to do what we can to fight this. Incredibly scary. ICE did not have the authority to hold the ambulance up but they did so at the point of a gun. What does that say about where the US is as “a nation of laws” and the republicans who for 50 years called themselves the party of law and order? Hugs
Late on Oct. 5, a Portland ambulance crew informed dispatchers over the radio that it was attempting to transport a patient from U.S. Immigration and Customs Enforcement to Legacy Emanuel Medical Center but that ICE officers were impeding its departure. Six minutes later, at 9:40 pm, according to publicly archived radio records, the medic driving the vehicle delivered an update: “We are still not being allowed to leave by ICE officers.”
Two confidential incident reports obtained by WW offer insight into what was going on inside the South Portland ICE facility at the time. The written accounts were filed by the ambulance crew members shortly after the incident—one report to their employer, American Medical Response, and another to a union representative—as documentation, as one report puts it, of a “conflict with federal agents.”
The two reports, filed by different medical workers, mirror each other’s accounts, and are consistent with publicly available audio recordings of emergency medical services radio communications, as well as 911 calls and dispatch reports obtained under public records law.
Both reports say that federal agents, in an effort to block the ambulance’s departure, stood directly in front of the vehicle. As the delay dragged on, according to the reports, the ambulance operator put the vehicle into park, causing it to lurch forward slightly.
The reports indicate the federal agents did not like this—so much so that an agent threatened to shoot and arrest the driver. The driver, frightened, asked why. An agent, according to the reports, responded that the driver had attempted to hit him with the ambulance.
“I was still in such shock,” the driver later wrote, “that they were not only accusing me of such a thing, but crowding and cornering me in the seat, pointing and screaming at me, threatening to shoot and arrest me, and not allowing the ambulance to leave the scene. This was no longer a safe scene, and in that moment, I realized that the scene had not actually been safe the entire time that they were blocking us from exiting, and that we were essentially trapped.”
The incident occurred at a contentious spot in the city. The ICE facility on South Macadam Avenue has in recent months been the scene of frequent and persistent protests, typically small in scale, which President Donald Trump has lately used to justify his effort to deploy military troops to Portland to protect federal facilities and the personnel that work in them.
Meanwhile, many, including Portland city officials, have alleged that federal agents have in several cases needlessly intensified situations that might have easily remained far more calm.
The incident described in the crew members’ two reports suggests that such hostility has been directed not only at demonstrators, but at first responders who were asked by the feds to assist. The ambulance was eventually allowed to leave the building with the patient. But the crew’s written reports of the preceding minutes offer a small but revealing sign of how on edge some federal agents working in the ICE facility are feeling—and how quick they are to take an aggressive posture when they perceive a physical threat, even from a fellow emergency worker.
WW first contacted U.S. Immigration and Customs Enforcement about the incident early last week. When WW followed up Friday, Oct. 10, with more details about what it planned to report, an ICE spokesperson wrote: “Please contact the Federal Protection Services for response.”
A subsequent email that day to the U.S. Federal Protective Service went unanswered. A media contact for the U.S. Department of Homeland Security, which contains FPS and ICE, did not respond to a request for comment either. None of the agencies responded to a follow-up email Oct. 11 asking for comment.
WW also sought comment from the ambulance crew members, the ambulance company, and the union representing the workers. None denied that the incident had occurred as described in the documents. The union added that when armed agents interfere with medical transport, they “cross a moral line.”
Public records provide greater context to the incident detailed in the crew members’ reports. The ambulance was called late in the evening on Oct. 5 to the ICE facility at 4310 S Macadam Ave. According to a publicly available dispatch document, the crew was responding to a medical call for a protester with a broken or dislocated collar bone.
By 9:13 pm, the ambulance was en route. According to a dispatch document, federal officials suggested at first that the ambulance enter the ICE facility through a side door, but then determined it should come in the main gate. The ambulance arrived on scene at 9:19. By 9:22, it had entered the building.
AMR ambulance on NE 82nd Avenue (Brian Burk)
A two-member crew was aboard. Both later documented the event in confidential reports. One record, reviewed by WW, appears on an event summary form produced for American Medical Response—the company that contracts to run ambulance services in Multnomah County. The document lists Oct. 5—the same day as the incident in question—as the “date submitted.” The other document is an email, sent by a crew member to a union representative. It is time-stamped the evening of Oct. 6.
The reports indicate that when the ambulance arrived, the patient was transferred into the vehicle without issue, and soon the crew was preparing to depart. This is consistent with other publicly available records. At 9:30 pm, the ambulance operator indicated plans over the radio to head to Legacy Emanuel Medical Center. Around 9:33 pm, dispatch records say, the ambulance seemed to be getting ready to bring the patient out.
And yet it was not emerging. What was going on? One crew member worked largely in the rear of the ambulance, while the other was sitting in the driver’s seat. Their respective reports offer consistent accounts from different vantages.
An initial delay, the driver’s report indicated, stemmed from federal agents’ desire to ride in the ambulance to the hospital. The driver recalls responding that, in the absence of arrest paperwork, officers could not ride in the ambulance, and that an agent responded this was OK—that agents would follow the ambulance to the hospital instead.
But the point was evidently not resolved. Before long, a report says, an agent again said the ambulance needed to wait for an agent who would ride along.
“I repeated again,” the driver’s report recounts, “that no officer is permitted to ride in the ambulance and that they can meet us at the hospital and that we needed to be let out of the facility. Officers then began walking away from me whenever I spoke. At that point, a group of 5-8 civilian-dressed men walked into the garage and just stared at me. No identification on any of them. I walked back to the ambulance and got into the driver’s seat. I flipped the emergency lights on and put the car into drive. I inched forward slowly out of the garage.”
At this point, a report says, a man in civilian clothes with a neck wrap covering the lower part of his face stepped in front of the ambulance and told the driver to halt. The ambulance driver, in the report, recalls telling the man not to stand in front of the ambulance, and that the man then yelled at the driver to stop, citing the risk of hitting federal agents.
The driver recalled expressing skepticism about the risk of hitting the large group of officers in full riot gear, in plain view, about 15 feet in front and to the left of the ambulance. Sensing that departure was imminent, the driver inched forward further: “The group of about 30 officers in front of the ambulance were lining up in what I assumed to be preparation for the gate to open so they could escort the ambulance off of the property,” the report says.
Time went by. The crew was anxious to get the patient to the hospital. But they were still being impeded. Several federal agents, many in riot gear, moved to stand “incredibly close” to the front of the ambulance, the driver’s report recounts. An agent approached to inform the driver of the presence of “violent protesters” outside—a new reason the ambulance could not yet leave.
Around this time, dispatchers received one of the crew’s radio messages: The ambulance was still being held up.
Public records document this period as well: “50-60 fed agents completely blocking the road,” a dispatch report said at 9:39 pm, “but AMR still not driving out yet.”
The gate to the ICE facility had opened and dozens of officers in riot gear had marched out, revealing a clear exit path. Still, according to an incident report, the smaller group of officers continued to stand directly in front of the ambulance.
Around this time, the crew member in the rear, having determined, as a report says, that the “yelling and aggressive nature of the officers had created a scene safety issue,” exited the ambulance to have a word with them.
“My partner was still in the driver’s seat,” the crew member wrote, “and I left the ambulance to attempt to calm and deescalate the situation.”
In the other report, the driver recalled observing this and moving to secure the vehicle before also getting out: “I then placed the ambulance into park, took my foot off the brake, undid my seat belt and opened the driver’s side door. I looked up and suddenly the entire group of officers…were crowded around the open car door, some of them leaning forward towards me, inches from my face.”
An agent, the driver recalled, “pointed his finger at me in a threatening manner and began viciously yelling in my face, stating, ‘DON’T YOU EVER DO THAT AGAIN, I WILL SHOOT YOU, I WILL ARREST YOU RIGHT NOW.’”
According to the driver’s report, the crew member who had been in the rear of the ambulance told the agent that the vehicle rolled forward when the driver put it in park, and that no one was trying to hit him.
To this, the report recounts, another agent replied that this was not the first time this had happened.
According to the medics, the agents continued to yell. There was also further chatter of riding in the ambulance, but in time an accord was reached: Feds would follow along in their own car.
By 9:42 pm, a crew member radioed in: They were finally en route to the hospital. The driver, in the report, recounts making this radio call, and that dispatch copied. The report says an unmarked vehicle with state license plates followed closely behind the ambulance, and upon arriving at the hospital, multiple men in civilian dress exited the vehicle and walked in.
Presented by email with details of this story, a spokesperson for Global Medical Response, the parent company of American Medical Response, did not answer WW’s questions, but said, “We are reviewing the specifics of the situation and committed to a thorough review.”
WW reached out to the two ambulance crew members. Both declined to comment.
Asked for incident reports tied to the medical call, Austin DePaolo, a spokesman for Teamsters Local 223, which represents the ambulance workers, said in an email that the union “doesn’t have any incident reports that members have given us permission to share.”
DePaolo added: “Our Teamster EMS workers answer every call with courage and compassion. When armed agents interfere with medical care, they cross a moral line that could put lives at risk. We stand firmly behind our members who work in EMS.”
Andrew Schwartz writes about health care. He’s spent years reporting on political and spiritual movements, most recently covering religion and immigration for the Chattanooga Times Free Press, and before this as a freelancer covering labor and public policy for various magazines. He began his career at the Walla Walla Union-Bulletin.
Willamette Week’s reporting has concrete impacts that change laws, force action from civic leaders, and drive compromised politicians from public office.
Fox is the tRump party media channel dedicated to ginning up as much outrage and social anxiety as possible to misinform and lie to the public. The goal is to keep the wealthy in charge and gaining ever more of the country’s money. Hugs
This is a doctor who served in Gaz and explains how horrible it is with Israeli soldiers shooting children as sport. He talks of dealing with children with their intestines hanging out and they have to operate with out pain killers. Please watch to see how horrific Israel is being at this point.
Sorry I have not been posting much. Really struggling right now. Hugs
Dr. Mohammed Mustafa joins us to discuss the horrors he has witnessed while volunteering at hospitals in Gaza. Here is a link to the fundraiser for a children’s hospital in Gaza. Live-streamed on September 23, 2025.
As part of historic cuts to Medicaid that will take health coverage away from millions, the Republican megabill enacted in July places a ten-year moratorium on implementing portions of two recently codified Medicaid eligibility and enrollment rules, effectively repealing them.[1] While these provisions are no longer mandatory, many remain optional. States can and should still voluntarily implement these approaches to streamline eligibility and ensure as many eligible people as possible enroll in and retain Medicaid coverage.
Congress blocked parts of two rules that were adopted by the Biden Administration to make it easier for eligible enrollees — particularly seniors, people with disabilities, and children enrolled in the Children’s Health Insurance Program (CHIP) — to get and stay enrolled in Medicaid or CHIP. The first rule, finalized in 2023, addressed many barriers that eligible seniors experience when accessing Medicare Savings Programs (MSPs).[2] The second rule, finalized in April 2024, codified many important policies that simplify the process for eligible people, including older adults and people with disabilities (the non-MAGI population), children, and pregnant people to get and stay enrolled in Medicaid and CHIP.[3]States should continue implementing optional portions of the rules to increase efficiency and further improve and streamline their programs so that eligible people can more easily get and keep their coverage.
States still must comply with the portions of the eligibility and enrollment rules that had already taken effect before Congress enacted the ten-year moratorium, which mostly affects parts of the rules that had not yet gone into effect.[4] The blocked provisions include amendments from the Centers on Medicare and Medicaid Services (CMS) to clarify and simplify long-standing regulatory provisions and mandates for states to follow newly created best practices. Even though some of these clarifications have been blocked, the underlying requirements remain intact, and states must follow them.
Importantly, though the blocked policies are no longer mandatory, they remain optional and are not in conflict with other regulations, except in a handful of cases. Because the blocked policies would have increased efficiency and improved and streamlined programs so that eligible people could more easily get and keep their coverage, states should proceed in implementing now-optional portions of the rules. In a few cases, blocked provisions are not allowed because of how existing regulations are written.
The two tables below outline the status of each provision in the final rules and whether it is still in place and required; blocked and now optional for states; clarifications are blocked but the underlying rules are still required; or blocked and no longer allowed.[5] Additional discussion of these provisions follows the tables.
Snip-they paste in ginormously, so I’m leaving them there, and referring you to the page, linked in the headline. The original table is also linked just below.
Source: HHS, “Medicaid Program; Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes,” 89 Fed. Reg. 22780, April 2, 2024, https://www.govinfo.gov/content/pkg/FR-2024-04-02/pdf/2024-06566.pdf.
States Should Continue Implementing Simplified Processes
Most states have already implemented parts of the rules that weren’t blocked, since those generally had effective dates that have already passed. Those provisions are still required, and states shouldn’t make any changes to those parts of their policies and systems.
As the tables above outline, the majority of the provisions that were blocked are no longer required, but they remain optional for states. Many states are likely in the process of implementing those provisions (or have already implemented them) and should continue moving forward with these changes that streamline eligibility for seniors, people with disabilities, and others.
Streamlining MSP Enrollment
The final rule includes a number of provisions for states to better facilitate and streamline MSP enrollment.[6] MSPs, administered through state Medicaid programs, offer significant help with the costs of Medicare premiums and cost-sharing to older adults and people with disabilities who are dually eligible for Medicaid and Medicare.[7] However, many more people are eligible for MSPs than are enrolled, and these provisions were aimed at increasing MSP enrollment among those eligible but not enrolled.
Provision Not Blocked, Remains Required
Automatic enrollment of certain Supplemental Security Income (SSI) recipients in the QMB eligibility group when they enroll in Medicaid (42 C.F.R. §435.909). People enrolled in Medicare who also receive SSI benefits are eligible for the QMB MSP group in addition to full Medicaid. However, many states require a separate application for QMB, which creates an additional layer of bureaucracy that deters eligible people from enrolling. This provision is aimed at removing this layer of bureaucracy and maximizing QMB enrollment.
The final rule requires 36 states and the District of Columbia, considered Part A “buy-in” states, to automatically enroll SSI recipients in the QMB eligibility group when they enroll in Medicaid. [8] The policy remains optional for 14 states that are referred to as “group payer” states, but these states should also strive to make enrollment for SSI recipients in QMB automatic.
Provision Blocked, Remains State Option
Aligning LIS and MSP family size definitions and income counting rules (42 C.F.R. §435.601(e)). CMS historically allowed states to apply their own definition of family size when determining household-based income limits for MSP eligibility. State MSP definitions that don’t align with LIS make it difficult for state agencies to expedite enrollment of LIS recipients into MSPs, since agencies often have to contact applicants for additional information if the definitions don’t align. The final rule required, and states can still implement, a definition of MSP family size to be “at least” those who are included in the LIS definition. States can also choose to align income counting rules for the programs to further streamline enrollment of LIS recipients into MSPs.
Accepting self-attestation for certain types of income and resources (42 C.F.R. §435.952(e)). Existing Medicaid regulations provide states the option to allow an MSP applicant’s self-attestation of all eligibility criteria except for citizenship and immigration status.[9] The final rule required states to accept self-attestation of certain types of income and resources such as non-liquid resources and burial funds up to $1,500 for purposes of determining eligibility for MSPs. States should accept self-attestation for these types of income and resources to further streamline MSP enrollment and reduce paperwork and documentation requests.
Clarifying the effective date of QMB enrollment for certain individuals living in “group payer” states (42 C.F.R. §406.21(c)(5)). The QMB Program pays for Part A premiums and Part B premiums, deductibles, copayments, and coinsurance. QMB enrollment for those who live in “group payer” states is particularly challenging. When states use the group payer arrangement to pay Part A premiums, certain enrollment restrictions apply, such as only being able to apply for Medicare Part A during the Medicare General Enrollment Period (January 1-March 31 of each year) if applicants did not enroll during their Initial Enrollment Period. The Part A effective date was recently changed to be the first month after enrollment, and the final rule aligned the QMB effective date with the new Part A effective date for those living in group payer states. States can still align their effective dates to ensure that eligible people receive the financial assistance they need to participate in Part A.
Using Low-Income Subsidy (LIS) data for MSP applications (42 C.F.R. §435.911(e)). Known as “Extra Help,” LIS helps pay prescription drug costs under Medicare Part D. LIS is federally administered by the Social Security Administration (SSA). Many people who enroll in LIS are eligible for MSPs, but state Medicaid agencies do not enroll them automatically.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires SSA to share data from LIS applications (‘‘leads data’’) with state Medicaid agencies and requires that, based on that data, agencies ‘‘shall initiate’’ an MSP application. However, not all states have done so. As a result, even though most of the over 14 million LIS enrollees are eligible for MSPs, over 1 million are not enrolled.[10] Using LIS data for MSP enrollment would significantly reduce the paperwork burden that applicants often face when applying for MSPs and would eliminate verification requests for information that the state Medicaid agency could access using LIS or other data. While a provision clarifying this rule was blocked, states are still expected to use LIS leads data from SSA to initiate an MSP application based on the MIPPA provision.
Alignment of Non-MAGI Policies With MAGI Practices
The Affordable Care Act’s (ACA) simplified eligibility and enrollment processes for MAGI enrollees were not extended to non-MAGI enrollees, including seniors and people with disabilities. As a result, non-MAGI enrollees often need to take additional steps to enroll and stay enrolled in coverage. The final rule sought to build on the ACA streamlining rules by aligning the enrollment and renewal processes for non-MAGI enrollees with MAGI requirements. Despite the moratorium, states can still take important steps to streamline procedures for non-MAGI enrollees.
Provision Not Blocked, Remains Required
Apply primacy of electronic verification and reasonable compatibility standard for resources (42 C.F.R. §§435.940, 435.952). The final rule also added provisions to clarify the requirements at 435.952 and 435.940 for states to implement and utilize asset verification systems to more seamlessly electronically verify non-MAGI enrollee assets at application and renewal,[11] and apply a reasonable compatibility standard for assets. Such a standard allows for self-attestation and information from data sources to be considered “reasonably compatible” if they are both below, at, or above the eligibility threshold, even if the amount of income in the attestation is different from the amount in the electronic data source.[12] This was expected of states based on how the original regulations were written, but many states did not interpret it as such. Reasonable compatibility is commonly used for income verification but was not required for asset verification. Under this policy, the client attestation and data source are considered “reasonably compatible” if they are both below the eligibility threshold, reducing requests for additional information. This provision was not blocked, so states must continue to apply primacy of electronic verification and a reasonable compatibility standard for assets.
Provision Blocked, Remains State Option
States have always had the option of aligning their MAGI processes to non-MAGI enrollees and most states have already done so.[13] Even though the reconciliation bill blocked provisions that would have made these options requirements, states that have not already adopted these options should still implement the streamlining practices, including:
Aligning the application and enrollment process with MAGI requirements (42 C.F.R. §435.907(d)). When requesting information from non-MAGI applicants, states should provide 15 days or more to respond and allow applicants to provide requested information through all modes of submission. States should also provide a 90-day reconsideration period if an application was denied for not providing the requested information, which allows for the requested information to be treated as a new application if submitted within 90 calendar days, rather than terminating an enrollee’s coverage and requiring them to submit a new application. States should also prohibit in-person interviews as part of the application process to reduce burden on non-MAGI applicants, many of whom may experience difficulties participating in an in-person interview due to mobility issues, lack of transportation, among other barriers.
Aligning the renewal process with MAGI requirements (42 C.F.R. §435.916). This includes renewing non-MAGI enrollees no more frequently than every 12 months, providing pre-populated renewal forms with a minimum of 30 days to respond, providing a 90-day reconsideration period[14] if an enrollee’s coverage was terminated for not completing the renewal process, and prohibiting states from requiring an in-person interview as part of the renewal process.
Implementing these policies will reduce red tape and administrative burden, making the application and renewal processes more accessible for non-MAGI groups and reducing both agency and client burden.
Allow non-MAGI applicants to provide applications and supplemental forms through all modes of submission allowed for MAGI applicants (42 CFR §435.907(c)(4)). Among the blocked policies was a provision that clarified an existing requirement (at 42 C.F.R. §435.907(c)) for states to accept applications and supplemental forms needed to complete an application from non-MAGI enrollees via all modalities (e.g., telephone, mail, online). Though the clarification was blocked, states still must accept applications and supplemental forms via all modalities as has been required, but not consistently applied, for non-MAGI groups.
CHIP Improvements
In addition to improvements for non-MAGI enrollees, the final rule also removed barriers to CHIP enrollment by prohibiting practices that were previously optional for states.[15] These provisions went into effect last year and were not blocked through reconciliation.
Provision Not Blocked, Remains Required
No CHIP lockout periods when premiums are not paid (42 C.F.R. §457.570(c)).
No waiting periods to enroll after becoming uninsured (42 C.F.R. §§457.65(d), 457.805(b), 457.810(a)).
No lifetime or annual limits to receiving coverage (42 C.F.R. §457.480).
Improved transitions between Medicaid and CHIP (42 C.F.R. §§431.10, 435.1200(b)1, 435.1200(b)(3)(vi), 435.1200(b)(4), 435,1200(c), 435.1200(e)(1)(i), 435.1200(e)(4), 435.1200h(3), 457.348, 457.350), including:
Requiring each program to also determine eligibility for the other program,
Accepting eligibility determinations made by the other program,
Transitioning applicants to the coverage they are or could be eligible for; and
Providing a single, combined eligibility determination notice to all household members.
Eliminating Barriers to Coverage
In addition to the policy improvements that addressed challenges faced by older adults, people with disabilities, and children, the final rule also made changes that better streamline Medicaid enrollment and renewal processes for all applicants and enrollees. Some of the provisions remain in place and, as with other sections of the rules, states still have opportunities to adopt many of the policies that are affected by the bill’s moratorium on elements of the rule.
Provision Not Blocked, Remains Required
Stronger recordkeeping practices (42 C.F.R. §§431.17, 435.914(a), 435.914(b), 457.965). The final rule modernizes recordkeeping rules that had not been changed since 1986 and includes requirements such as maintaining records in an electronic format, specifying what information related to an enrollee’s application or renewal should be included in the file, maintaining records for a minimum of three years, and specifying how and when states should make the records available to outside agencies or parties authorized to review them.
No limit on the number of reasonable opportunity periods (42 C.F.R. §435.956(b)(4)). State agencies are required to provide a “reasonable opportunity period” of 90 days to provide satisfactory proof of citizenship or immigration status when the agency is unable to verify an individual’s attestation. The final rule restricts limitations on the number of reasonable opportunity periods that an applicant may be granted, giving people more opportunity to secure documents from agencies that can be slow to respond.[16]
No requirement to apply for all other benefits (42 C.F.R. §§435.608, 436.608). Old rules required Medicaid applicants and enrollees to apply for income and resources (benefits) “available” to them such as pensions, retirement, and disability benefits as a condition of their eligibility (unless they could show good cause for not doing so). This rule imposed administrative burdens on individuals seeking health coverage and often delayed the application process. The final rule removes the regulation and redefines the income and resources “available” to applicants and enrollees as only those that are within their immediate control, effectively eliminating the requirement to apply for other benefits as a condition of eligibility.
Facilitate enrollment by allowing “medically needy” individuals to deduct prospective available medical expenses (42 C.F.R. §§435.831, 436.831).“Medically needy” individuals have incomes too high to be eligible for Medicaid but have medical costs so high that they are able to “spend down” to become income-eligible for Medicaid. Previously, medically needy individuals had to submit documentation of the expenses they incurred before their Medicaid coverage kicked in. In some cases, this led to people churning in and out of coverage depending on the timing of their medical costs and agency procedures to verify financial eligibility. The final rule lets state agencies project those medical expenses that are constant and predictable into the future, allowing enrollees with ongoing medical needs to remain enrolled without breaks in coverage.
Provision Blocked, Remains State Option
Improving Medicaid agency processes for updated address information (42 C.F.R. §§435.919, 457.344). The final rule sought to standardize a process for state agencies to update enrollee contact information, including specifying which data sources are considered reliable, what actions agencies should take when receiving address updates (or when returned mail has no forwarding address), and requiring agencies to make a “good-faith effort” to contact an enrollee to confirm updated address information through two or more modalities, such as via text and email. While this provision of the rule was blocked through the megabill, beginning on October 1, 2029, a separate section in the new legislation requires state agencies to collect updated address information from reliable data sources, including returned mail and managed care entities, and delegates authority to the Secretary of HHS to specify what actions states can take after receiving updated address information.[17] While awaiting further guidance from CMS, state agencies should continue to implement the best practices the final rule sought to standardize around obtaining updated address information and contacting enrollees to resolve discrepancies.
Establishing specific requirements for acting on changes in circumstances (42 C.F.R.§§435.919, 457.344, 457.960). Enrollees are required to report changes in circumstances that could impact their eligibility during their eligibility period, and state agencies are required to act on such reports or on data they receive that indicate a change that could impact eligibility. The final rule outlined procedures for state agencies regarding changes in circumstance, such as communicating to enrollees the process for reporting changes, and actions the agency must take when they receive information about an enrollee’s change in circumstance. The rule also applied the same timeliness standards for enrollees to respond when changes are either reported by them or if the state receives data indicating a change. These include providing enrollees 30 days to submit requested information and providing enrollees a 90-day reconsideration period so the enrollee does not have to fully reapply. Though this provision was blocked, states can still implement these best practices to better streamline the process for addressing either enrollee-provided information that could affect eligibility or information received from a third party (such as through a data match).
Ensuring reasonable timeframes for determinations and redeterminations at application, renewal, and following changes in circumstance (42 C.F.R. §§435.907(d), 435.912, 457.1170). The final rule established more specific timeliness requirements for states to adhere to when processing renewals and changes in circumstance. The rule also required states to provide a minimum number of days for individuals to return requested information and documentation to their state agency — 15 days for information requested at application and 30 days for information requested during a renewal or for a change in circumstance. Though this provision was blocked, state Medicaid agencies can use the timeframes laid out in the rule for their application and renewal processes, and notably, they still cannot terminate coverage for individuals who have returned their information until their renewal is fully processed.[18]
Provision Blocked, No Longer Allowed
Simplifies verification of citizenship and identity (42 C.F.R. §435.407). Currently, states are required to verify citizenship and identity first through SSA data, and if unsuccessful, through alternative methods such as state vital statistics records or through the U.S. Department of Homeland Security (DHS) Systematic Alien Verification for Entitlements (SAVE) program. When these systems are used to verify citizenship, individuals must also provide proof of identity. This provision would have considered verification of birth with a state vital statistics agency or verification of citizenship with DHS SAVE as stand-alone evidence of citizenship (similar to SSA data) without needing to provide additional proof of identity. Due to the moratorium, states will still have to request verification of identity when using these sources to verify citizenship.
[1] Because the bill placed a moratorium on implementation of the rules, the Code of Federal Regulations may still show new provisions added by the two rules, even though they are not currently in effect. Throughout this paper, we refer to the provisions that are temporarily blocked by the moratoria provisions in sections 71101 and 71102 of P.L. 119-21 as “blocked” provisions.
[3] HHS, “Medicaid Program; Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes,” 89 Fed. Reg. 22780, April 2, 2024, https://www.govinfo.gov/content/pkg/FR-2024-04-02/pdf/2024-06566.pdf.
[4] While the House bill initially blocked the entire rule with minimal exceptions, the Senate Parliamentarian ruled that additional provisions could not be blocked, presumably because they were already in effect.
[5] A number of provisions in the final rules included miscellaneous changes that did not change policy, such as changing references, definitions or language used to describe something, removing headings, and removing and redesignating sections. Such sections include 42 C.F.R. §§ 431.213(d), 431.231(d), 435.4, 435.222, and 435.911(a).
[7] Some individuals who are eligible for both Medicaid and Medicare receive full Medicaid benefits along with Medicare and may also receive assistance through MSPs. Partial dual eligibles are enrolled in Medicare and receive assistance from MSPs to help afford that coverage. Medicaid and CHIP Payment and Access Commission (MACPAC), Medicare Savings Programs, https://www.macpac.gov/subtopic/medicare-savings-programs/.
[8] All states must pay the Part A premium for QMB enrollees who do not receive premium-free Part A; “buy-in” states include the Part A premium cost for QMBs in their existing buy-in agreement, which helps facilitate automatic enrollment in QMB any time of the year. When states use the group payer arrangement to pay Part A premiums, certain enrollment restrictions apply, such as only being able to apply for Medicare Part A during the Medicare General Enrollment Period (January 1-March 31 of each year) if they did not enroll during their Initial Enrollment Period (three months before turning 65 and three months after the month the individual turns 65, lasting seven months total). CMS, “Program Overview and Policy: Chapter 1,” https://www.cms.gov/files/document/chapter-1-program-overview-and-policy.pdf.
[14] Section 435.919(d): “If an individual terminated for not returning requested information in accordance with this section subsequently submits the information within 90 calendar days after the date of termination, or a longer period elected by the State, the agency must reconsider the individual’s eligibility without requiring a new application.”
[16] When people enroll in Medicaid they are asked under penalty of perjury if they are a citizen, and for those who aren’t, if they have an eligible immigration status. In both cases the application asks applicants to provide relevant government-issued document numbers. These numbers along with other information about the applicant is shared through electronic data exchanges with either the Social Security Administration (SSA) in the case of a citizenship attestation or the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) in the case of people with eligible immigration status and citizens who completed the naturalization process. Many people can have their status verified easily and quickly through this process, but some cannot. For example, SSA can’t always substantiate citizenship of people born abroad if their Social Security number (SSN) was issued prior to the late 1970s, before SSA began verifying citizenship status when issuing SSNs. Because it can take time for agencies to notify the applicant that more information is needed, for the applicant to find and send documents, and for the agency to take steps to process documents, multiple reasonable opportunity periods are sometimes necessary.
Scottie's Playtime 