WAKE FOREST, N.C. -- Early-childhood educators are finding themselves choosing between basic needs and health care. The median salary for child-care workers in North Carolina is not quite $21,000 - too high to qualify for Medicaid, but leaving many early-childhood educators in the gap.

A new report from one group that advocates for Medicaid expansion in North Carolina interviewed early-childhood educators from across the state, and 1-in-5 said they don’t have health insurance. One educator who asked to be referred to as "Eryka," said she plans her budget very carefully each week for rent, food, electricity, and gas to get to work. But buying private health insurance is far out of reach for her.

She said that means she goes to work even when she’s sick.

"Most of the time, I kind of just have to ride it out and hope I get better. Otherwise, I am going to the ER, wasting their time, or the urgent care, wasting their time, for something small,” Eryka said. “If I had strep throat, I have to go pay $75, $100, to go to urgent care just to get antibiotics. Nothing is easily accessible when you don't have good health insurance."

Two measures in the state Legislature, House Bill 5 and Senate Bill 3, would raise the income level for those eligible for Medicaid. Senate Leader Phil Berger, R-Eden, took aim at provisions in both bills, saying it represents a tax that ultimately will be passed on to patients and taxpayers.

Bills in the House and Senate propose to use federal funding to expand access to Medicaid, as 37 other states already have done. Leaders from both parties and the governor have different approaches to increasing access to health care, but would need to reach a compromise in order to actually pass legislation this session.

Statewide, it's estimated that 500,000 people are in the "coverage gap," earning too much for Medicaid. Among them are thousands of early-childhood educators such as Meranda who said that while she enjoys working with toddlers, the fact that she's been uninsured for more than a year is frustrating.

"If they expanded Medicare, it would be such a huge burden lifted off,” Meranda said. “Then I wouldn't have to worry about getting sick and how long I am going to stay sick for. Am I going to get OK, or is this something serious because I have cancer that runs in my family. All four of my grandparents had it, my great-grandparents had it, my mother had it."

Members of the Early Childhood Advisory Council appointed by Gov. Roy Cooper wrote to legislators last week to share how expanding Medicaid to close the health-insurance coverage gap can help the state's more than 1 million young children.

Reporting by North Carolina News Connection in association with Media in the Public Interest and funded in part by the Park Foundation.


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The California Parent and Youth Helpline turns five years old today - just in time for a brand new study that confirms its effectiveness.

The study, published in the Journal of Technology in Human Services, found that 85% of people felt more positive, calmer and less angry after calling in.

Lead author Elizabeth Harris, a sociology professor at Arizona State University, said that kind of result is rare in social science research.

"Parenting interventions are expensive and difficult to do," she said. "Most interventions take months to take effect, so to be able to do an effective intervention in 30 minutes, that's a big deal."

The data also show about one-third of callers improved significantly on the scale - meaning they either went from making all negative statements to feeling 100% neutral, or they started off neutral and said they felt "100% positive" by the end of the call.

Parents and youths in distress can reach a trained counselor at 855-427-2736, 12 hours a day, seven days a week. Or they can reach out online at CAparentyouthhelpline.org.

Smith said the data show the helpline is especially effective at making people feel heard.

"Fifty percent of people who are lonely and isolated in their parenting role, they feel less of that by the end of the call," she said. "So, it shows that in less than 30 minutes, it's possible for a trained counselor to make a measurable difference."

She explained that the research used what's called sentiment analysis and secondary qualitative analysis, and validates the approach taken by Parents Anonymous, the group that runs the helpline.

CORRECTION: The number of foster care referrals received by Bethany Christian Services is 200 each month. A previous version of the story incorrectly stated it as 200 per year. (2:43 p.m. MDT, May 12, 2025)

May is National Foster Care Month and in Pennsylvania, more than 15,000 children are waiting for foster families. Their advocates are urging more people to open their homes to help.

Carrie Eckhardt, assistant director of domestic services for Bethany Christian Services of the Greater Delaware Valley, said their goal is to support families and children through quality social services. She shared a quote from the mother of Elle, a girl from a tough background who is now thriving thanks to a foster parent who adopted her.

"She's made honor roll every quarter, tried out for and made a sports team at her school, enjoys her youth group, volunteers with a club of her peers and in our church," Eckhardt outlined. "She handles her homework, manages her emotions, completes her chores, fills up her social calendar. I'm just along for the ride, cheering her on."

Eckhardt pointed out the group focuses on child welfare, refugee help and keeping families together, and aims to have enough homes for the 200 foster care referrals it receives each month.

Diakon Adoption and Foster Care helps around 4,000 children a year in 30 Pennsylvania counties, including support after adoption through the Statewide Adoption Network. The Steel family has been fostering with Diakon for 12 years, caring for 21 kids.

Hannah Steel, an adoptive sibling, said in a Diakon-made video her adopted sister Maya struggled at first but is now doing well.

"When she first came to us, it was a little stressful and a little different for her," Steel recounted. "But as time progressed and everything, we all learned how to live together and understand each other. And I think for her, she's made it a long way."

Patricia Menow, senior director of permanency for Diakon, said they use social media and take part in community events to raise awareness about the ongoing need for foster families and to reach as many people as possible.

"We offer 'Triple P,' which is a positive parenting training program," Menow explained. "That's an ongoing program from the time they start coming through as a resource family, through while they are a foster family."

Alyssa Snyder, executive director of permanency for Diakon, said it is important to understand there is a great need for more foster parents and organizations like hers can support families of all types.

"There's no blueprint for this," Snyder acknowledged. "We support individuals who have this interest and ability, and the youth that are coming into care deserve to live in a family. So, we just want to encourage folks to consider that for all ages of youth."


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Ohio's child care system is under strain and a new national report highlighted how Medicaid helps support the workforce behind early childhood care, especially in rural communities.

Medicaid provides critical coverage for child care providers, many of whom are low-paid and often go without employer-based insurance.

Brittany Boulton, vice president of the policy and advocacy organization Groundwork Ohio, said it is especially vital for rural families.

"Cuts to Medicaid would make these problems far worse and leave thousands of Ohioans and rural families without access to coverage and care," Boulton pointed out.

A report by the Georgetown University Center on Children and Family Studies said 30% of children in rural Ohio rely on Medicaid for health coverage, placing the state among the top 10 nationally for rural child enrollment.

National experts warned access to health care is essential not only for children but also for those who care for them.

Daniel Hains, chief policy and professional advancement officer for the National Association for the Education of Young Children, said there is a clear link between health coverage and workforce stability. He noted about 16% of early educators lack insurance and those who do have coverage are more likely to stay in the field.

"We need more highly qualified, well-supported, well compensated early childhood educators, with 25+ percent of early childhood educators relying on Medicaid for their own health insurance," Hains noted. "With the critical supports the program provides for their education and for the children and families they serve."

Ohio's child care sector has lost nearly 6,000 workers since the pandemic began and Groundwork Ohio said access to Medicaid helps retain educators in a field facing critical staffing shortages.