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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Medi-Cal has dropped several hundred thousand low-income children from the health insurance rolls since April 2023, according to a new report from Georgetown University.

The data show a net drop in children's Medi-Cal enrollment of 200,000 kids between April and December of last year, as the state started redetermining participants' annual eligibility - which had been paused to ensure continuous coverage during the pandemic.

Mayra Alvarez, president of the Children's Partnership, said another 100,000 have been dropped this year.

"Some 80% of the people that lose coverage in California are losing it for procedural reasons," said Alvarez, "not because they're not eligible but because their paperwork didn't make it to the county, or they waited too long on the line and got frustrated and had to hang up, or they moved and the letter never even reached them."

The state of California has made a massive outreach effort to keep those who are eligible covered.

More than half a million children, half of California's kids, depend on Medi-Cal. And three quarters of them are children of color.

It is unclear how many kids who lost Medi-Cal were later enrolled in private coverage.

Joan Alker is a co-author of the report, and executive director of the Center for Children and Families at Georgetown University. She said gaps in coverage can lead to long-term negative impacts.

"Kids are going to miss out on those well-child visits, they're going to miss out on getting the medications they need," said Alker, "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."

A few years ago, California lawmakers passed a requirement for continuous coverage in Medi-Cal for children ages zero to five.

Alvarez said she is urging them to follow through and allocate $10 million in the next state budget to fulfill this mission.

After Texas, a new report shows Florida has seen the second-largest decline in the number of children enrolled in Medicaid and the Children's Health Insurance Program.

Of the 4.16 million fewer children enrolled in Medicaid and CHIP nationally, Florida accounts for nearly 600,000 enrollment declines - according to a report by Georgetown University's Center for Children and Families, tracking the Medicaid unwinding since COVID-related coverage protections were lifted.

Alison Yager, executive director with the Florida Health Justice Project, said it's more like a crisis has been unfolding in Florida - and they've long been sounding the alarm.

"This, at its most extreme, can be a question of life or death, really," said Yager, "and short of that, we're seeing far too many families having to now scramble to figure out what's going to change in their monthly budget so they can now pay for whatever medication their kids require."

Yager cautioned that even if families qualify for one of Florida's KidCare programs, there are gaps in coverage.

Going without insurance, even briefly, can cause people to delay seeking care and leave them financially vulnerable when they do.

In February, the state sued the Center for Medicaid Services to stop them from enforcing 12 month continuous eligibility in the state's CHIP program.

The report is based on administrative data from the states to the Centers for Medicare and Medicaid Services.

Joan Alker - executive director of the Center for Children and Families at Georgetown - said Texas, Florida, Georgia and California accounted for half of the total national decline in kids with health insurance.

"This is a real crisis in these states for families whose children rely on Medicaid, but also for the providers that serve them - pediatricians and clinics," said Alker. "The system is really getting shaken up."

An April survey by KFF reveals that almost one fourth of adults who were removed from Medicaid - the program for low-income individuals - after pandemic-related protections ended last spring, now report being uninsured.

The need for child care and early learning is critical, especially in rural Arkansas. One nonprofit is working to fill those gaps by giving providers a chance to get more education.

The Career Pathways Program with Save the Children partners with universities to grow the workforce of child care and preschool providers.

Joyce Taylor, Eastern Arkansas parent-family community engagement coordinator for Save the Children, had more than 20 years' experience with Head Start and said the program gave her the opportunity to pursue a bachelor's degree. It also provides her with resources she can use, in the classroom and with families.

"In particular, we have a family with a child that is autistic," Taylor noted. "Mom is working with the child at home. So I have things that I can share with that family, so she can continue to work with her child."

More than 153,000 openings for child care workers are projected over the next decade, largely driven by the need to replace those who have left the field or retired, according to the Bureau of Labor Statistics.

Taylor pointed out some children have challenging behaviors, and may have a lot of things going on at home. It is her job to help them thrive in preschool.

"Because we're the first start, when they come into Head Start, that's their first opportunity to be in a learning environment," Taylor explained. "It's up to us to do everything that we can do, to help make that first experience successful."

Karen Harrison, managing director of career in education workforce development for Save the Children, said rural areas have access to fewer resources compared to urban areas, so the program focuses on addressing the specific gaps in rural communities. She added the Pathways program aims to reduce barriers to obtaining a higher-ed credential or degree.

"All of our pathways come with incentives," Harrison emphasized. "We either pay all or partial of their tuition; we pay stipends, for books, supplies and materials. We also give 'barrier reduction' stipends. We know that child care for participants themselves can be an issue; transportation, technology needs."

Harrison added the pathway begins with a Child Development Associate credential, followed by an associate degree, and ultimately a bachelor's degree. In the process, they improve the career opportunities for workers, as well as the quality of early learning.