AUSTIN, Texas – After more than a decade of progress getting health coverage for more children in the U.S., a new report shows that nationally, more than 800,000 fewer children were enrolled in federal health programs at the end of 2018.
Anne Dunkelberg, associate director at the Center for Public Policy Priorities, says nearly 146,000 fewer children in Texas were enrolled in Medicaid and the Children's Health Insurance Program (CHIP).
She says the new data is cause for alarm because it comes on the heels of the first reversal in coverage progress reported just a year ago.
"If you're concerned about the future of Texas and our competitiveness and to have a strong, well educated work force, you have to be concerned with child well- being, and public schools are a part of that, and so is health care," she stresses.
More than 3 million children in Texas currently are covered through Medicaid and another 400,000 through CHIP.
The Trump administration attributes drops in coverage to a strong economy and lower unemployment, factors that tend to move people from government programs to employer-sponsored health insurance.
Dunkelberg says many Texas families earn too much to qualify for Medicaid, but can't afford employer-subsidized insurance, which costs up to a quarter of their gross income.
Report author Tricia Brooks, a senior fellow at the Georgetown University Center for Children and Families, says employment and economic growth have been steady over the last decade, but the positive trend hasn't translated into coverage gains for children.
"There was no surge in employment or real wage growth that would account for the enrollment plunge in 2018,” she points out. “There also is negligible evidence that any economic factors have substantially increased access to affordable private or employer-based coverage for low- to moderate-income families. "
The report suggests other factors, including budget cuts to services helping families navigate the complicated enrollment process, have contributed to a drop in coverage.
Dunkelberg adds the Trump administration's immigration policies also have created a chilling effect, and many Texas parents have to make difficult decisions.
"I can allow my U.S. citizen child to enroll in this health insurance program, or I can choose to stay out of it because as a family we are afraid that it's going to keep mom or dad from getting their permanent resident status or becoming a U.S. citizen," she states.
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An evidenced-based social work model to help parents struggling with substance use stay connected to their children is offering hope to Ohio counties ravaged by the opioid epidemic.
A new survey of parents in predominantly Appalachian Ohio counties finds most had positive experiences with Ohio Sobriety Treatment and Reducing Trauma or "START."
Erin Mills, Ohio START family peer mentor for Summit County Children's Services, said the program uses a trauma-informed approach to help parents forge healthy relationships with their children, while voluntarily agreeing to enter a recovery program.
"It's an amazing tool within the community as we are facing this opioid epidemic," Mills asserted. "We have tons of children who are being displaced due to addiction issues."
According to the survey, many parents gave credit to Ohio START for helping them keep custody of or reunite with their children, and say their experiences led to a more positive perception of child protective services. According to 2022 state data, more than 5,000 residents died from drug overdoses and the majority of the deaths involved opioids.
Jen McClellan, Ohio START regional manager for the Public Children Services Association of Ohio, explained substance abuse in the home increases the odds of child abuse and neglect but pointed to research which shows removing children from their home and placing them in foster care can cause mental distress and in some cases, lead to worse outcomes.
She believes the program's success is driven by its use of peer mentors and wraparound services aimed at keeping parents and kids together safely.
"We use more intense practices, the family peer mentor is paired with a caseworker who serves the families together," McClellan explained. "And they see their families much more frequently than in a traditional Children's Services case."
Jessica Okolish, Ohio START family peer mentor for Summit County Children's Services, said the intensity and speed of recovery services to participating families can help set in motion positive changes, noting without the START network, parents could wait months for a bed in a recovery program.
"Another big thing is recovery coaches having a seat at the table to show the positive impact of peer support and that it works. I think Summit County has proven that." Okolish reported.
Most survey participants said the shared lived experience between family peer mentors and parents helped established trust and made a difference overcoming resistance in working with child protective services.
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Advocates for accessible child care saw wins during Washington state's legislative session this year but still see room for improvement.
Lawmakers invested in a number of programs to increase funding for child care providers.
Genevieve Stokes, director of government relations for Child Care Aware of Washington, said the state is building a foundation for universal access for families.
"The investments this year were modest but still really tackled some of the crucial things that we were hoping they would look at," Stokes acknowledged.
Some of the investments include $1.75 million for free infant and early childhood mental health consultations, more than $8 million for the Early Childhood Education and Assistance Program, and nearly $7 million in additional grant money for capital improvements for early learning facilities.
However, Stokes emphasized gaps remain.
"The funding this year and the funding so far doesn't address the child care crisis for middle-income families," Stokes noted. "And it doesn't solve the issue of child care providers not being able to make a living wage."
Stokes added not finding care puts parents in a bind and impacts the economy.
"When parents can't find child care or can't afford child care, they can't work and then they're faced with impossible choices with few good outcomes," Stokes stressed.
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This month is National Disability Awareness Month, and in Ohio, parents who've adopted kids with special needs say living with a disability isn't always a barrier to independence and thriving.
Aaryn McGregor, a nurse in Richland County, said her husband adopted 15-year-old Samantha from foster care nearly four years ago. Samantha was born without some of her organs and was placed in foster care as a toddler because of medical neglect.
With both physical and cognitive disabilities, Samantha has high needs for day-to-day care, but McGregor said she's made progress in her new home and is learning independent-living skills.
"We realize they have a disability, but we also want to see past that a little, just so that they can reach their full potential, it's not just the label, because people of all ages with disabilities, they can achieve a lot in their life. We think that's important," McGregor said.
Research shows children with disabilities have significantly more disruptions and longer stays in foster care. Of the more than 680,000 children in the U.S. foster care system in 2017, 22% had a medical or disability diagnosis requiring additional or specialized care.
Rita Soronen, president and CEO of the Dave Thomas Foundation for Adoption, said no matter what race, age or background, children with any type of disability or special needs are more likely to linger in foster care or age into institutional care. She said it's important for families interested in adoption to build a network of support, and points to the Wendy's Wonderful Kids Program as a model for pre-adoption relationship-building.
"Making those connections -- access to medical or psychological resources that they'll need before that adoption is finalized -- is critical, so that families feel that they will be supported, that they will have access, and that they can successfully raise a child in their home," she explained.
According to the Dave Thomas Foundation, its Wendy's Wonderful Kids Program is responsible for more than 14,000 successful adoptions across the United States and Canada.
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