The federal COVID-19 public health emergency may be over, but there is lingering concern about the mental state of children. In South Dakota, a pre-pandemic program pulling communities together to prevent youth adversity, is taking flight amid these concerns.

The Center for the Prevention of Child Maltreatment gives South Dakota communities a framework to improve harmful home environments for kids.

Heidi Gullickson, executive director of the Brookings Area United Way, helps lead her region's Resilient Communities plan.

She said they educate community members about the warning signs of abuse or neglect, and there are conversations about the type of support at-risk households need in order to have stability.

"It's not just one thing happening in a family," Gullickson pointed out. "In a situation, there's usually multiple prongs that are happening, and so, how do we just come around each other and step in when that need is there?"

Added support could include closing transportation gaps, or making sure households have enough food to eat.

Brookings County is the first South Dakota area to successfully implement the program's framework. A grant through the South Dakota Community Foundation means several new communities are expected to begin the process this year.

In trying to establish a shared sense of preventive work, Gullickson noted community members are learning more about how Adverse Childhood Experiences, such as violence in the home or losing a caregiver to COVID, can negatively affect long-term outcomes for kids.

"Getting the word out of what that is, and having the CDC guidelines and all of those kinds of things to back up this evidence-based information, has been beneficial to our community," Gullickson asserted.

Organizers cited research showing people with at least one Adverse Childhood Experience have an increased risk of cancer, heart disease, depression and obesity. Those with an ACE score of six or higher could see their life span shortened by 20 years.

Gullickson added so far, they have trained 625 community members about ACES and their impact.

More than 300,000 children have been dropped from Medicaid and Peach Care for kids since the pandemic ended.

A report from the Georgetown University Center for Children and Families pinpoints a nationwide trend: More than 4 million kids were left uninsured, soon after the COVID public-health emergency ended.

Georgia ranks third-highest for the number of children who have lost coverage.

Judy Fitzgerald, executive director of Voices for Georgia's Children, said many lost coverage because of procedural reasons rather than eligibility.

"They're not ineligible, but there was missing or incomplete paperwork, or what we know from families is, they felt like they didn't receive the notification, they didn't know," she said. "And so, there are a large number of children who are still eligible."

Fitzgerald said the repercussions of disenrollment can be dire, as when children can't get timely access to health-care services, they're more vulnerable to illnesses and developmental delays. The report also found parents with access to employer-sponsored health plans can't always afford the cost of adding their dependents.

While parents face higher income requirements for Medicaid, many children who lost coverage during the pandemic are still eligible. Fitzgerald said Voices for Georgia's Children is advocating for ways to increase enrollment for children, including a more simplified enrollment process and assistance from state agencies to expedite screening.

"So, we're asking the state to expand the kinds of organizations that could screen kids for eligibility, and enroll them in coverage temporarily while the state processes an official enrollment," she added, "and this is something called presumptive eligibility."

She said programs such as SNAP, and information through the Department of Labor, could be used to facilitate renewals. For families who don't qualify, she said, alternative coverage options are available through the insurance marketplace. Navigators through Georgians for a Healthy Future can help find them.

The Medicaid and Nevada Check Up programs had more than 13,000 fewer children enrolled last year than during the pandemic, according to new research from the Georgetown University Center for Children and Families.

States have been reexamining Medicaid benefits since the pandemic ended, and disenrolling families based on their head-of-household's eligibility. Carissa Pearce, health policy manager for the Children's Advocacy Alliance, said this means some children were also dropped from coverage who are still eligible.

As a result, she said, the Centers for Medicare and Medicaid Services told states to stop disenrolling and ensure they were looking at individual eligibility.

"Meaning that children would be screened separately from their parents, and that was a really important change," Pearce explained. "Specifically in Nevada, every person who had been disenrolled up to that point in August and September of 2023 were reinstated for their coverage, so that they could fix their system and then proceed with disenrollments."

Pearce said Nevada didn't start disenrolling children again until January of this year, giving families more time to check the requirements and submit the documentation to keep their coverage. But from January to February, about 1,500 Nevada children were dropped. She said it's important for families to see if their child is eligible for Nevada Check Up or consider a state marketplace insurance program at nevadahealthlink.com.

Tara Raines, deputy director of the Children's Advocacy Alliance, said her message to families is to not avoid medical appointments if they suspect their child may not be covered. She said there are other programs that families can be directed to, and thinks the state could do more to reach and inform families.

"I think a campaign that lets people know, 'Hey, you were disenrolled from Medicaid, here are your options,' would be incredibly helpful," she said, "and I don't know if that looks like partnering with school districts."

Raines said families' living conditions and circumstances vary in the Silver State. This could mean some may not have a permanent address, but should not mean they go without health coverage.


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More than one million children in Texas no longer have health insurance through Medicaid, despite being eligible for coverage, according to a new report from the Georgetown University Center for Children and Families.

During the COVID-19 pandemic, states were not allowed to cancel coverage - then last year, state health departments were tasked with rechecking the eligibility of Medicaid recipients.

Brittney Taylor-Ross, senior policy analyst with the advocacy group Every Texan, said despite the option to slowly complete the task, Texas chose to do it in one year's time.

"We didn't take up a lot of the flexibilities that were offered, so that was a state choice at the leadership level. We also chose to go through this unwinding process pretty quickly. Other states have paused their process when they've seen that things don't look right," Taylor-Ross said.

The report shows Texas has disenrolled more children than any other state. Anyone who lost coverage must reapply. Taylor-Ross said as of April, the median amount of time to process a new Medicaid application is 95 days. Federal law requires this number to be 45 days or less.

Most families don't realize they no longer have coverage until they go to the doctor's office.

Joan Alker, research professor, McCourt School of Public Policy, and executive director, Georgetown University Center for Children and Families, said the problem affects not only families, but the pediatricians and clinics that treat them.

"Kids are going to miss out on those well-child visits, they're going to miss out on getting the medications they need - be it an inhaler for their asthma or an ADHD medication. And that really sets them back, both in their health and their success in school," she said.

Because of the unwinding, more than 4 million fewer children are enrolled in Medicaid. One out of four of those children lives in Texas.