INDIANAPOLIS -- A new report shows that Medicaid plays a larger role in rural communities in Indiana than it does in larger cities.

The report, "Medicaid in Small Towns and Rural America," looked at all 50 states and found about 45 percent of children in small towns and rural areas rely on Medicaid for their coverage, compared to 38 percent in metro areas. Rylin Rogers with Family Voices of Indiana said these are children dealing with conditions such as asthma, sickle cell anemia, cancer and developmental disabilities, including autism.

She said not only are more rural kids affected by these conditions, the small towns they live in often don't have specialty care centers.

"So, if you need a pediatric cardiologist, you likely are going to need to get that care from an urban environment,” Rogers said. "In Indiana, most of that care happens in the central part of our state, the children's hospitals."

According to the report, 75 percent of kids with these specialized medical issues live in low- or middle-income families. Proposals from President Donald Trump and the U.S. House would slash $1.4 trillion from Medicaid over the next decade.

Rogers said many Indiana families even have to travel to other states for care, which means long road trips with sick children - plus the cost of food and hotel stays. And Medicaid takes that into consideration.

"Thinking about making sure that kids have access to the care that they need in the closest environment, and that they have coverage, including Medicaid,” she explained.

The report, from the Georgetown University Center on Children and Families, also found the Affordable Care Act's Medicaid expansion has had a greater positive impact in small towns and rural areas than in urban areas. It said cutting Medicaid would have a negative impact on rural health centers and hospitals.

More information is available at KFF.org


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A persistent child care worker shortage across New Hampshire is leaving families with few options.

The state is currently short more than 7,000 child care positions but low wages and burnout are driving workers from the field and forcing some centers to close.

Shannon Tremblay, director of the New Hampshire Child Care Advisory Council, said workers are struggling to care for their own families with wages barely above the federal poverty line.

"No one wants to come in for a low wage," Tremblay pointed out. "No one wants to come in making $15 an hour, working long hours in a stressful environment."

Tremblay argued greater state investment will create long-term benefits for both parents and children, some of whom may have disabilities or behavioral issues which could be identified earlier by trained child care staff.

Last year, state lawmakers invested more than $60 million in child care services, including $15 million for the creation of child care workforce grants and investments in the state's Family Resource Centers.

Tremblay emphasized the end of career and technical education programs in New Hampshire high schools broke the pipeline of workers entering the field, putting greater pressure on current staff to do it all.

"Our providers are the case manager, the cook, the plumber," Tremblay observed. "They want to provide that high-quality care and right now it's just, they can't do it."

Tremblay stressed pandemic-era funding to support the child care industry will run out in September, so state lawmakers need to act. She added the state could increase wages so the burden does not fall on New Hampshire families, who currently spend roughly $24,000 a year on care for two children under age five.

The child welfare system in Pennsylvania faces a staffing crisis affecting children and families throughout the system.

The Child Welfare Resource Center said about 30 counties report caseworker vacancy rates of 30% or higher

Terry Clark, president and CEO of the Pennsylvania Council of Children, Youth and Family Services, at a state Senate hearing on child welfare, challenged the Departments of Education and Human Services to work together to develop a STEM-focused model for human services. It could offer young people opportunities for training, apprenticeships and careers in child welfare, juvenile justice and behavioral health.

"We spend a lot of time focusing on colleges and universities," Clark noted. "But we believe we might want to back this up a little bit, and start looking at middle schools and high schools. Try to reinvigorate, get younger students motivated and trying to come into this field."

Clark pointed out some agencies have asked supervisors and even people from other departments to take on casework responsibilities. A recent Philadelphia study found Community Umbrella Agencies had an average 45% turnover rate, with vacancies ranging from 21-60 positions.

Clark observed private providers face workforce challenges similar to the county child welfare agencies. He emphasized counties are beginning to explore more contractual relationships with private providers for needed work.

"Counties are starting to put out RFPs, calls for private providers to help supplement their workforce," Clark stressed. "That means they're asking private providers to take on roles and functions that, in the past, were primarily done by counties themselves."

Clark argued competitive wages are seen as crucial to attract and retain child welfare workers, and county funding often falls short. He added student loan forgiveness and fellowship programs may be promising ways to bring new people into the field, but lawmakers would have to agree.

"There have been House bills and different Senate bills that have been introduced, or at least in draft form over the years," Clark acknowledged. "We hope that there's continued discussion about those, because if we can get some movement on those, we think those will really help."

He told legislators the turnover trends will not change significantly without increased investment in workers.

Despite a recent policy victory, Wisconsin labor leaders still express concern about the current environment for shielding young teens from unsafe work environments.

Gov. Tony Evers this month vetoed a bill which would have expanded the elimination of required work permits for those younger than 18. The bill's language applied to 14- and 15-year-olds, several years after the state did away with parental permission for 16- and 17-year-olds.

Stephanie Bloomingdale, president of the Wisconsin State AFL-CIO, said the recent debates are policy fights advocates thought they won decades ago when minors often worked in dangerous conditions. She cautioned there is a strong push to chip away at protections.

"We are seeing a growing movement from different, unscrupulous employers that want to put kids back in the workplace, and not have the kind of oversight that is needed," Bloomingdale contended.

The Economic Policy Institute said rollbacks have been approved in a dozen states in the past few years. While current efforts are thwarted in Wisconsin, Bloomingdale worries about similar debates in future sessions.

Meanwhile, violations are trending upward, with the U.S. Labor Department reporting an 83% increase in financial penalties. Backers of the Wisconsin bill said the goal was to reduce red tape for families.

Bloomingdale countered taking away another layer of protection does more to trample on the rights of parents and guardians. And with higher consumer prices placing more pressure on household budgets, she added some kids might feel the need to bring in additional income.

She emphasized the current law helps the whole family make an informed decision.

"It's important for kids to get a good work ethic," Bloomingdale acknowledged. "But at the same time, these kids need to make sure that they are getting enough sleep, that they are able to participate in their school, and really making sure that balance is there."

The Economic Policy Institute report showed amid the push in many states to weaken laws, several other states have advanced bills to strengthen protections. There have been bipartisan bills in Congress which, among other things, would crack down on violators.


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