Nebraska saw nine long-term care facility closures in 2022, second only to 13 in Texas.

In the past three years, Nebraska has lost a combined 29 assisted living facilities and nursing homes. Inadequate funding for Medicaid patients, workforce issues and the rising costs of goods and services have all contributed to these closures.

Two bills to be heard in the Unicameral's Appropriations Committee today would mean substantial increases in state and federal funding for both types of facilities.

Jalene Carpenter, Nebraska Health Care Association CEO, says additional funding is crucial to stem the state's long-term care crisis.

"In Nebraska, 15 counties do not have a nursing home or an assisted-living [facility], and we are really starting to see a 'care desert' be created. And that causes significant issues for Nebraska seniors, " Carpenter expressed.

LB-941 would increase the daily reimbursement rate for assisted living residents on the Medicaid Waiver program. The new daily rate of just under $79 is based on a Nebraska Department of Health and Human Services study. LB-942 would increase the nursing home Medicaid reimbursement rate by about 5% over the next year. Both bills were introduced by state Sen. Myron Dorn, R-Adams.

Carpenter says the COVID-impacted long-term care workforce is improving in the state, but she stresses Medicaid reimbursement rates play a large part.

"A large portion of the Medicaid rate -- when you look at what it covers -- it's primarily going towards labor and benefits. Nursing-facility and assisted-living care is very hands-on, and we need adequate rates to be able to attract and retain team members," she added.

Carpenter said the state, educational institutions and organizations, including the Nebraska Health Care Association, are also focused on building the long-term care workforce -- including introducing young people to careers in health care and strengthening Certified Nursing Assistant programs.

"We're trying not only to increase the rates so that our facilities can attract and retain (employees), but then also, as an association, to look at other ways to drive people into the workforce for this profession, " she said.

In 2023, Gov. Jim Pillen approved a one-year, 3% increase in the Medicaid reimbursement rate, but vetoed the Legislature's 2% increase for the second year.

Child care advocates are pushing for increased funding as the budget deadline approaches this Friday.

Robyn Schelp, director of policy and advocacy for Kids Win Missouri, said ensuring increases to child care subsidies remain in the budget are vital for every Missourian whether they have children or not.

"It impacts the entire workforce," Schelp pointed out. "We have to stop thinking that this is a parent's issue. It isn't. If we want teachers in the classroom and doctors at their offices and whatnot, we have to make sure there's childcare for their kids."

The legislature adjourned after just about 10 minutes on Monday, following a record 41-hour filibuster which went to 4 a.m. Thursday without agreeing on a budget. Missouri lawmakers have only missed the budget deadline one time, in 1977.

Sen. Cindy O'Laughlin, R-Shelbina, the Senate Majority Leader said on social media Friday the Missouri Freedom Caucus only yielded the floor under the threat of a motion to end debate. She tried to introduce the Federal Reimbursement Allowance, which she said is crucial for funding to offset general revenue and vital for Medicaid services.

The budget includes child care subsidies under House Bill 2002. Schelp noted the House's proposal would support only 23,000 children, restricting expansion and compliance with federal guidelines.

"Our hope is that it stays with the governor's recommendation, of that $52 million," Schelp emphasized. "Allowing them to go to that 100th percentile of payment for infants and toddlers and then the 65th percentile for preschool and afterschool."

Sen. Bill Eigel, R-Weldon Spring, is leading an effort to convince fellow members of his party to approve abortion restriction legislation and a bill on ballot initiatives in Missouri before agreeing to a vote on the reimbursement allowance.

A plan to use public money to fund vouchers for students to attend private schools is drawing pushback from Louisiana teachers, who say the plan could devastate the public school system.

The program making its way through the Louisiana Legislature would be first available to low-income students and by the 2027-2028 school year, it would be available to all students.

Larry Carter, president of the Louisiana Federation of Teachers, predicts the plan could cause significant budget cuts for public schools.

"These universal voucher bills are a step in the wrong direction," Carter argued. "We've seen in other states around the country, like Arizona and Ohio, where these bills have been passed, they're now facing a budget crisis, and we're hoping that we cannot go down that same road."

Carter pointed out the education savings account program known by the acronym LA GATOR would allow as much as $7,500 per student from families below 250% of the Federal Poverty Line, and $5,000 for those who make more.

The plan, House Bill 745 and companion Senate Bill 313, has been approved by the state House. The Senate is expected to vote on it by Friday or Monday.

Carter explained teachers are concerned classroom standards currently mandated for public schools would not be upheld in private or parochial schools.

"We want to make sure it has some accountability," Carter emphasized. "We think that's at least giving all education stakeholders and parents an opportunity to talk about whether this program is successful or not. And through accountability practices, we think that will help."

There is concern the plan would force public schools to eliminate many positions and needed programs. Carter fears the loss of funds could deprive students of the benefits of a public school education.

"If we're cutting that funding stream, Louisiana students will have fewer nurses and counselors, less options for after school program, and certainly limited access to field trips and AP courses that help prepare them for their next step in life," Carter outlined.

New York City advocates are excited yet concerned about the 2025 budget.

In recent weeks, funding was restored to certain education programs such as shelter-based community coordinators. They helped more than 40,000 city students living in temporary housing. Funding for school psychologists and social workers was also restored.

Randi Levine, policy director at Advocates for Children of New York, said other programs need to be saved.

"Funding is running out for the Mental Health Continuum, which is a program that provides students in 50 schools with access to expedited mental health care, and is very important especially when we have a youth mental health crisis," Levine asserted.

Other programs facing cuts include restorative-justice practices which help schools reduce suspension. The budget's feedback has been mixed considering many programs will stay, although some could still be cut. Although the programs began using short-term funding, Levine feels their lasting effects in a post-pandemic world make them a permanent necessity.

Immigrant education programs are on the chopping block too. Promise NYC provides child care for kids regardless of their immigration status, and the immigrant family communication and outreach initiative helps parents who do not speak English learn about their kids' school.

Murad Awawdeh, president and CEO of the New York Immigration Coalition, said it would be a mistake to cut funds for things such as the language access program.

"That program, which would expand language access across the city of New York, which would build an interpreter bank as well as build translation cooperatives across the city and could save the city millions of dollars, was defunded and not restored," Awawdeh pointed out.

He added the recently passed state budget does give New York City enough funding to restore certain initiatives, but not enough to bolster others. Awawdeh argued with housing unaffordability continuing and people struggling to make ends meet, the city has to step up to aid everyday New Yorkers.


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