Medicaid and the Children's Health Insurance Program have been a lifeline for struggling families during the pandemic - and a new report suggests more than six million children in the U.S. could needlessly lose that coverage.

A "continuous-enrollment" requirement will be lifted at the end of the public-health emergency, which could be as early as April.

The federal government then gives states 12 months to re-determine people's eligibility. But Ohio's new state budget calls for that work to be completed in 90 days.

Kelly Vyzral, senior health policy associate with the Children's Defense Fund-Ohio, said the shorter timeframe could lead to families being erroneously dropped from coverage.

"There are workforce shortages that are affecting Ohio Medicaid just like they're affecting every other business in Ohio, and they've got an enormous caseload to go through," Vyzral. "And we want to make sure that every family and every child that is eligible for Medicaid is able to maintain that coverage."

The findings from the Georgetown University Center for Children and Families indicate a nearly 12% increase in Ohio children enrolled in Medicaid and CHIP between February of 2020 and June 2021. That's roughly 134,000 kids at risk of losing coverage.

More than half of all children in the U.S. are enrolled in Medicaid and CHIP. Executive Director of the Georgetown University Center for Children and Families Joan Alker says 37.3 million kids are currently protected by continuous coverage.

"This mass and unprecedented eligibility redetermination process holds great risk for children and their families," said Alker. "And that risk will vary depending on where they live."

Positive measures Ohio has made to cover families are noted in the report, including expanding Medicaid under the Affordable Care Act and merging the Medicaid and CHIP programs.

Vyzral said they've also eliminated other red tape.

"They offer 12-month continuous coverage for families and children," Vyzral. "They have been improving their level of passive renewal, so that families don't have to continue to submit information if Medicaid can verify that through existing data and records they have."

She said she's hopeful Ohio will take advantage of the 12-month allowable time frame for redeterminations.

Republican-sponsored bills and amendments in the Legislature would eliminate the Tennessee Commission on Children and Youth. More than 1.5-million children live in Tennessee. TCCY said it is a critical component of keeping children's issues front and center.

Kylie Graves, policy specialist for the Tennessee Commission on Children and Youth, said it was never consulted about the legislation, and the text in the amendment would remove any mention of the agency from the state code. She added that dismantling the commission will cause Tennessee to lose the only entity that works to address the well-being of children.

"So very short turnaround there, kind of a mix of trying to wrap our heads around what the amendment does, what it would mean for us to be completely deleted from code, it would mean that we would no longer exist, and all of our programs would have to go elsewhere if they were to continue, " she said.

Graves added the commission is reaching out to legislators who will be voting on the bills, explaining the value the panel brings as an independent consolidated state agency. Two measures are in play in the legislature. House Bill 330 will be presented before the House Children and Family Affairs Subcommittee today and Senate Bill 282 will go before the Senate Health and Welfare Committee tomorrow.

Graves said the commission has partnered with the Annie E. Casey Foundation's Kids Count for more than 30 years and they set up the infrastructure and collect data for reports. She noted the foundation will not partner with another non-independent state agency to do this work because of trust and reliability.

"To us, that's just another clear example of how we were not consulted on this legislation or where programs will move because the Kids Count work, including the State of the Child, the county profiles, our data center, all of that cannot go to another state agency. And so nonprofits will have to pick up that work," she added.

Graves said the commission is the only state agency tasked with looking at issues across the childhood spectrum and making recommendations to improve those systems, and added the 21-person board is made up of members appointed by the governor and can serve up to nine years. At least one member is appointed from each of Tennessee's nine development districts.

A recent report on the child welfare workforce shortage looks at how worker turnover, recruitment, and retention are impacting children and families in the care system.

The Philadelphia Child Welfare Workforce Taskforce made recommendations to the City's human services department to improve it.

Samea Kim - Vice President of Legal and Public Affairs for the Pennsylvania Council of Children, Youth, and Family Services - said they surveyed 281 workers in Philadelphia's child welfare system and found that a lack of funding was the number one issue.

"In our survey," said Kim, "when we asked participants what the top five factors are that would cause them to leave this field, over 80% of respondents noted that salary was probably the number one factor for them in sort of determining their future in this field."

Kim said they found the average salaries of foster care providers and community caseworkers was thousands of dollars less than a Philadelphia DHS employee, and added that 44% of child welfare workers had a second job to supplement their income.

Kim explained that they also studied the employee turnover rate in foster care.

Prior to the COVID-19 pandemic, the child welfare workforce struggled with recruitment and retention, and Kim said average turnover rates of 20% to 40% were not uncommon.

"When we looked at the Philadelphia community umbrella agencies, most recently, their average turnover rate was 45%, which is a pretty high departure from pre-pandemic levels," said Kim. "It's also really far from what is seen as a manageable or sort of good turnover rate of 10%."

Kim emphasized that the report found high turnover rates led to workload increases for remaining caseworkers, making them reconsider their future in these jobs.

Kim said the task force also recommended additional funding to reduce the workload for new caseworkers, and allow agencies to hire a bullpen of providers who can be on standby when the caseload spikes.

Knowing how to hold space for the grief of children can be complex, but learning how to do it is vital for their well-being.

A death in the family is always traumatic, but deaths due to overdose bring their own unique pain and are on the rise. The National Institutes of Health reports U.S. overdose deaths reached a record of more than 106,000 in 2021, a near 20% increase from the year prior.

With those statistics in mind, the nonprofit National Alliance for Children's Grief will be focusing on the aftermath of overdose deaths as it holds its national conference and webcast in Baltimore March 21.

Vicki Jay, CEO of the alliance, said grief stays with people as they age, and we owe it to kids to address their grief head on.

"The cost of inaction affects the health of our kids, the emotional health, their academic performance, their relationships, all of the above," Jay explained. "It's so much easier in my opinion, to address grief when it affects a child rather than waiting 'til they are a broken adult and try to fix that."

Estimates indicate one in 12 children in Maryland will experience the death of a sibling or parent by age 18.

Family members and children of those who die as a result of a substance-use disorder have often experienced a complex and unreliable relationship with the person. Jay explained the inconsistency can affect the sense of trust in a child.

"If you live in an environment where people are not themselves much of the time, who do you trust and who do you turn to and what is real and what is not real?" Jay emphasized. "Those kinds of things are scary for kids."

When children carry grief with them, it can change through time as they experience life's milestones without their person. At times grief may take the form of acting out, and Jay added adults need to be mindful of a child's experience of loss.

"When a child misbehaves at school, we assume that was his goal that day," Jay pointed out. "'I got up and decided I wanted to draw my teacher crazy,' without looking beyond that and say, 'Why is this child struggling in the classroom?' And many times it goes back to loss and changes in his own personal life."