This year, West Virginia lawmakers made significant changes to drug and alcohol treatment programs funded by Medicaid, which many people use. The new legislation ties Medicaid payments to patient outcomes rather than the number of patients served.

The Mountain State has the nation's highest overdose rates, and overdose death rates among Black residents exceed those of any other group. In this episode of Us & Them, host Trey Kay learns how Medicaid funding supports organizations working in recovery and what that work looks like on the ground.

This episode of Us & Them, recently honored with a Regional Edward R. Murrow Award for Excellence in Diversity, Equity and Inclusion, is presented with support from The Greater Kanawha Valley Foundation.

Daniel Johnston, a visual artist and singer-songwriter from West Virginia made his mark in the indie music scene of the1980s. His raw and unpolished style earned him a label as an outsider artist, and a place in the state’s Music Hall of Fame. Johnston recorded his best-known songs on cassette in his parents’ basement in Hancock County. Songwriters saw past the lo-fi production values and musicians like Nirvana’s Kurt Cobain championed his work. Johnston was diagnosed with bipolar disorder in his 20s, and as his fame grew, his mental health struggles increased. He died in 2019 at age 58, leaving hundreds of songs and drawings. In this award-winning episode of Us & Them, host Trey Kay talks with family members, musicians and others about Daniel’s life and legacy.

Hundreds of thousands of kids rely on America’s foster care system. West Virginia has the highest rate of foster care placements of any state - four times the national average. Foster care is most often needed because of parental substance use, mental health challenges, poverty and neglect. Six-thousand Mountain State kids are in foster care, but there’s a shortage of licensed foster homes and residential facilities and that’s why nearly 400 kids live in out-of-state institutions. On this Us & Them, an encore episode finds more than half of all states have seen their number of licensed foster homes drop, some by as much as 60 percent because many new foster parents don’t stay in the system for long.

While official foster care cases are tracked and overseen by state agencies, many types of so-called kinship care are not official or included in state data.

Psychedelic drugs are getting attention from the Trump administration as treatment potentials for some mental health conditions. An executive order from President Trump fast tracks research and access to the drugs, which can carry health risks. On the latest episode of Us & Them, host Trey Kay checks back on someone who’s been using an illegal psychedelic called ibogaine to help people kick addictions. Ibogaine can alter brain functions and is used in some countries to treat depression, anxiety, PTSD and drug withdrawal symptoms. Twenty years ago most U.S. doctors wouldn’t touch the drug and politicians stayed away from it but now, the prospects for psychedelics in America may be changing.

The 250th anniversary of the Declaration of Independence arrives at a moment when Americans are arguing not just about politics—but about our nation’s history. As President Donald Trump calls for the removal of what he labels “divisive” history from public institutions, a new documentary from Ken Burns revisits the American Revolution with all of its complexity, contradiction, and competing visions of freedom. In this episode of Us & Them, host Trey Kay brings together professors and students at Marshall University in Huntington, West Virginia along with community members for a public conversation. There’s talk about what the revolution meant then, who it was for, and what it means now—at a time when questions about executive power, citizenship, and belonging feel anything but settled.

For some Americans home ownership is a way to build wealth for future generations. But West Virginia presents the complexities and nuances of that reality. The Mountain State has the nation’s highest homeownership rate but the second lowest personal income rate. And much of the state’s housing is old and needs repair. In one West Virginia county, 67 percent of the homes are more than 80 years old and half rate below normal on standard quality measures. By several measures there are 500,000 people living in such conditions. In this encore Us & Them — which was recently honored by the Virginias Associated Press Broadcasters for Best Podcast — we travel just across the state line to Western Virginia to experience a side of the housing crisis we don't often see — structures in disrepair that people call home.

There are more challenges now for people who live at the intersection of addiction, homelessness and the criminal justice system. New laws in about a dozen states echo aspects of the 2024 Safer Kentucky Act, which enhances penalties for violent crimes, drug crimes, shoplifting and carjacking, and bans public camping. On this encore episode of Us & Them, host Trey Kay returns to Kentucky to check on the consequences of the new tough-on-crime law. In cities, the demand for long term and transitional housing remains acute, while in small town Appalachia the access to any social safety net can be far, far away.

Children are often described as the future. But in many rural communities across America, the path to bringing a child into the world is getting longer — sometimes literally. Across the country, families are traveling farther and farther from home to deliver babies. Since the end of 2020, 124 rural hospitals have closed or announced plans to close their labor-and-delivery units — about two closures a month. As small hospitals struggle with rising costs and staffing shortages, obstetrics departments are often among the first services to disappear. In this encore episode of Us & Them, host Trey Kay hears from families living with those changes — and explores what the loss of maternity care could mean for the future of rural towns and communities.