TALLAHASSEE, Fla. – Failure to to expand Medicaid in Florida means the Sunshine State has one of the highest uninsured rates for women of child-bearing age, according to a new report by the Georgetown University Center for Children and Families.

It says Medicaid expansion is helping to fill gaps in maternal health coverage, which experts say leads to healthier mothers and babies.

But Alison Yager, director of policy advocacy for the Florida Health Justice Project, points out that growing numbers of women of reproductive age – between 18 and 44 – are unable to take care of themselves prior to pregnancy and a couple months after birth, when they typically lose gap coverage.

"And that means again that these women – who are now at this vulnerable time in life where they are taking care of a new baby – are unable to take care of themselves because they've lost their connections to care and, again, any chronic conditions," Yager stressed.

The uninsured rate for these women is 19% in Florida, compared with the 9% average in states that have expanded Medicaid.

Critics of expansion say they are concerned about increased costs under the the Affordable Care Act.

The report found that states that expanded Medicaid coverage have sharply lower rates of uninsured women of child-bearing age, which has contributed to reduced infant deaths.

Joan Alker, executive director of the Georgetown University Center for Children and Families, says steady, uninterrupted coverage makes a difference for healthy birth outcomes.

"Things like maternal-depression screening and treatment, treatment for substance-use disorders, smoking cessation – all of those are benefits that Medicaid can and does cover," said Alker. "So, those are likely to have really positive, two-generational impacts."

Researchers found that Medicaid expansion improved maternal health outcomes by increasing access to preventive care, and also reduced adverse health outcomes before, during and after pregnancies.

States that expanded Medicaid also saw a 50% greater reduction in infant mortality rates, compared with states that have not expanded coverage.

The report was released in conjunction with the March of Dimes and the American College of Obstetricians and Gynecologists.

Maryland ranks second in the nation for charging children who have committed crimes as adults. But one expert says a more trauma-informed response in the justice system would better serve those young people. In fiscal year 2023, more than 3-thousand Maryland youth were charged with committing a violent crime - or a nonviolent felony. Another 8-thousand were charged with misdemeanors.

Joseph Ribsam, director of child welfare and juvenile justice policy with the Annie E. Casey Foundation, said it's common for juveniles in the justice system to have traumatic experiences. He adds trauma screenings of juveniles before they even head to court would allow the justice system to know the best way to help them.

"Oftentimes, the type of offenses that we think of that would be required to separate a young person from community are also the same types of offenses that are displayed when somebody's engaged in dysregulated behavior, which is the type of behavior that somebody who's been exposed to trauma significantly would engage in," he explained.

A report by Human Rights for Children finds Maryland ranks behind only three other states in the number of people who were imprisoned for crimes they committed as children.

According to a 2021 study, 23% of detained girls and nine percent of detained boys meet the diagnostic criteria for post-traumatic stress disorder. Ribsam said some actions taken by the justice system do not help address trauma - and at times even exacerbates the problem.

"If you really start to understand what are the drivers of the behaviors, you can find the right solution, and might find that the right solution doesn't even need to involve a justice system at all. It does start with actually understanding the needs, and not always presuming that behaviors are best solved with punitive responses," he continued.

Ribsam added that increased access to treatment and therapy would best serve juveniles in the justice system, too.

Concerned parents are pushing the authorities to help parks and day cares remove sand from sandboxes contaminated with ash after the Los Angeles fires.

The City of Pasadena sent crews to remove the top two inches of sand from sandboxes in local parks. Los Angeles County recommended the same thing but so far is not funding the remediation.

Juana Sanchez, a mother of two toddlers in Eagle Rock, said she has been calling authorities, to little avail.

"I called my local park to hear what steps were taken to remediate ash," Sanchez explained. "I was told, well, our park has been raking the sand daily and power washing all durable surfaces. That just effectively disturbs ash so that it's no longer visible."

When asked about sand removal, the Los Angeles County Department of Health said no one was available for an interview. Sen. Sasha Perez, D-Los Angeles, who represents areas affected by the Eaton fire, has called for more soil testing.

Sanchez pointed out small day cares that survived the fire may not be able to afford to clean up their sandboxes and play yards.

"Can someone quarterback this? Can someone show leadership on this issue?" Sanchez asked. "My concern is that right now, it's like a political hot potato that nobody wants to touch and that we'd rather pretend doesn't exist."

Cristina Alvarado, executive director of the Child Care Alliance of Los Angeles, said many small day cares serving low-income communities of color are facing big bills in their quest to reopen safely.

"In terms of cleaning, there are some grants available," Alvarado noted. "We are also going to be giving some stipends, you know, to child care providers, as much as we were able to obtain from donors. I think that there, there are efforts to help them clean. I know that we've been talking to some of the big toy manufacturers to see if they can donate sand for the sandboxes."

The Child Care Alliance has also distributed buckets of cleaning supplies and air purifiers to day cares downwind of the fire zone.


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Many Tennessee families cannot afford child care and providers cannot afford to pay their staff fair wages, according to a new report.

The nonpartisan ThinkTennessee found families spend 41% of their income on child care, forcing tough choices for many.

Erin Hafkenschiel, president of the group, said child care is a major affordability issue, alongside housing and health care. With 165,000 job openings each month and 50,000 unfilled, she pointed out the child care shortage makes it harder for companies to find and keep workers.

"We are hearing from parents that they are not able to stay in the workforce, return to the workforce after having kids," Hafkenschiel reported. "Or even if there's some other sort of life change that happens, they're not able to stay in the workforce because it's simply unaffordable."

She added a lack of affordable child care costs the state more than $2 billion annually in lost earnings, productivity and tax revenue. The report also found 32% of parents had to turn down a promotion, raise or job opportunity because of child care issues.

Hafkenschiel noted child care providers face licensing and zoning hurdles, making it tough to open new facilities.

"One of the examples that we explore in our brief are zoning regulations," Hafkenschiel explained. "There might be a zoning regulation in a city that is keeping a child care center from being open in more of a residential neighborhood."

ThinkTennessee is looking at other states for ways to cut child care costs. Hafkenschiel emphasized one idea is to put child care centers in workplaces or schools, where rents could be more reasonable and savings could be passed along to families.

"Another example that we've seen that's worked really well in other states, not yet here in Tennessee, but is what's called a Tri Share Program, where you essentially are sharing the cost," Hafkenschiel outlined. "An employer could potentially contribute. The family, of course, contributes. And then either the state and/or local government contributes."

The report laid out four recommendations to expand child care and support workers. It suggested easing regulations to allow more centers to open, encouraging businesses to offer child care, find ways to improve job quality for child care workers and invest in affordable care for low-income families.


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