With the pandemic era ending, Medicaid annual renewals are unwinding in Missouri.

Eligibility for Medicaid is being verified and more than 54,000 residents have already lost coverage in June and July.

Timothy McBride, professor of public health at Washington University in St. Louis, said 24% are deemed to be ineligible while 23% are still pending review.

"Of those losing coverage, 74% in the first two months were procedural violations," McBride explained. "What that means is that the state dropped their coverage. Probably means they did not submit paperwork."

Professor McBride emphasized half of those who have lost Medicaid coverage in Missouri are children.

Children make up the majority of the Medicaid population, but they are also the most eligible group. McBride pointed out 31,000 children are still pending Medicaid eligibility review, and added it is concerning when they disproportionately make up too high of a percentage of those losing or pending coverage.

"You can see that a higher proportion of the children are in the pending category than even in the losing coverage category, which is actually pretty high as well," McBride emphasized. "So not only is it not great that half the people losing coverage already are kids but 60% are pending, so that number of people losing coverage is certainly going to go up."

Nationwide Medicaid enrollment rose to a record high during the pandemic, and in Missouri the enrollment also rose to a record of more than 1.5 million people.


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Skills for reducing violence are becoming essential in schools. At the beginning of the school year, students at a Washington state high school participated in a workshop aimed at doing that. The Alternatives to Violence Project mostly works in jails and prisons around the world. This time, Evergreen High School in King County was the host.

Roger Kluck, executive director, Projects for a Civil Society, the Puget Sound area organization that offers the training locally, said the COVID-19 lockdown is still affecting kids' behavior.

"The kids have lost social graces, social skills, social emotional skills," he explained. "They don't know how to get along with each other after not being in the classroom for long periods of time."

Kluck's organization was not able to offer the workshop to all 1,000 students at the high school, so it was just for ninth graders this year. To have enough staff, Kluck added they put out an international call. Three facilitators traveled from New Zealand and three traveled from Kenya to participate.

Kluck said the ninth graders were timid at first and were reluctant to answer questions in large groups, so they broke the numbers down.

"If we put them in groups of two, three or four, they really enjoyed talking to each other," he explained, "and we'd have them share what's your favorite activity? What do you enjoy doing? What's something about yourself that nobody knows?"

Kluck said the training operates under the idea that "hurt people hurt people."

"A lot of our violence prevention works in healing people from their own psychic pain and teaching them to be empathetic and compassionate, because if I see you as being like me it's much harder for me to want to do violence to you," he continued.

Kluck said his organization plans to bring the Alternatives to Violence Project again to freshmen at Evergreen High School next year.


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Over the next couple of weeks, kids across Minnesota will head back to school. Addiction specialists say now is a good time for parents to address any concerning behavior in their child's online habits. Internet addiction is not formally recognized yet in a key reference tool from the American Psychiatric Association.

But Dr. Sara Polley, Minnesota-based child & adolescent psychiatry specialist and director of addiction psychiatry at Ellie Mental Health, feels it will eventually be considered a disorder. For adolescents, being on social media too much can be harmful to brains that are still developing, she said. So, if they have been spending a lot of time online this summer, parents need to re-establish healthy habits.

"It's really helpful to discuss with your family a media plan that applies to both the children in the family and the parents in the family, with potentially specific times set aside for use of social media or use of the internet not related to completing school assignments," she explained.

She also recommended "tech-free zones" in places like the kitchen, in hopes of sparking more family conversations. If your teen becomes combative when asked to limit screen time or is becoming socially withdrawn and only prefers to be online, Polley said it is time to seek advice from a family doctor or mental health professional.

Polley added pushing above the "three-hours-a-day" mark of social media use can put adolescents at greater risk for depression and anxiety. It can also prevent them from getting a good night's sleep, making the back-to-school transition problematic.

"And when I ask young people, 'What are you doing when you're up late at night?' - nearly 100% of the time, they say that they're on their computer, they're using social media, they're watching videos on YouTube." she continued. "And that can make it really difficult for them to do what they need to do during their usual full-time job, which is going to school."

Other experts worry the effects could result in disruptive behavior in the classroom. Middle school and high school students are often sent home with tablets and laptops for school use. They might come with settings limiting what can be done online, but Polley said it is still good for parents to set their own boundaries. Those could include only allowing the devices to be used in the living room, or making sure they are placed in backpacks when homework is completed.


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Mental-health coverage and using digital devices to communicate with doctors' offices are among the health-care priorities of Generation Z. Providers are urged to make note of the needs of patients born between the late 1990s and the early 2010s. Industry researchers say like a lot of other age groups, Gen Z embraces telemedicine. But as these individuals begin to navigate adulthood, they also value apps that make it easier to schedule appointments, manage conditions and look up data.

Richelle Andrae, government relations specialist with the Wisconsin Primary Health Care Association, said more importantly, this generation wants to feel empowered when receiving care.

"I don't think a Gen Z individual is really likely to just be directed to what to do with their health care," she said. "They need that buy-in and options so that they can have a voice in the process of providing care."

She said Gen Z deserves praise for normalizing conversations regarding behavioral health amid nationwide calls to expand mental-health care and insurance plans to cover those expenses. According to Y-Pulse data, 71% of consumers in this age group say they value brands that incorporate mental health as part of their marketing.

Dr. Donald Tavakoli, national medical director for behavioral health with United Healthcare, said Z is just starting to enter the workforce. Because they report higher rates of depression, eating disorders and even suicidal behaviors, he said it is important they understand terms such as deductibles, co-insurance and out-of-pocket when signing up for plans.

"They have significant rates of mental illness, so we think it's really important that they first have their health insurance lingo down - really understanding the common terms of how to navigate health insurance," he said.

Industry experts say because they prioritize their mental health, these individuals are likely to seek out employers who offer packages with quality behavioral health coverage.

Health equity is another priority for Gen Z. Andrae said her organization, which is the member association for community health centers around Wisconsin, is trying to reduce access barriers for underserved populations, including young adults and adolescents.

"They may not have a parent or a family member or a guardian who can take them to a clinic after work," Andrae said. Maybe that parent or guardian is working multiple jobs."