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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This month marks the 25th anniversary of a federal law designed to give states flexibility in helping older kids transition out of foster care.

States such as Nebraska have updated their programs, but advocates say services are still underutilized. In 1999, the U.S. government enacted a law that gives states money to carry out independent living programs for kids in foster care, soon to be adults. But the Annie E. Casey Foundation says fewer than half of those eligible receive services.

Hope Cooper, who leads the Journey to Success campaign to raise awareness of this issue, said these kids often face a steep climb at a key stage in life.

"They faced a lot of adversity in their early years," she said, "and we have the opportunity - and we really have to meet that opportunity - to provide some really targeted, additional supports to smooth that climb."

Nebraska's program, which is voluntary, saw more than 340 young adults participate in 2022. The Casey Foundation said only about one in four successfully completed it.

National advocates have urged state and federal lawmakers to do all they can to close gaps. This past year, Nebraska opted to include youths aging out of the juvenile justice system who lack any family support.

Cooper said a range of services under these state-level programs can help with things such as job training and housing stability. Beyond the federal law, she said other forms of support have emerged.

"We're trying to create more educational stability for young people during their junior high and high school years," she said, "and creating more supports for young people as they go and pursue higher-education opportunities."

On a broader scale, she said some "fine-tuning" is needed to implement these programs, to ensure they meet their potential. A number of states have also extended foster care to youths beyond age 18 to help with these transitions. Nebraska's independent living program serves 19- to-21-year-olds.

As winter sets in, advocates are spotlighting the need for after-school programs to provide Indiana youth with safe spaces to build skills, stay engaged, and foster positive relationships.

Research shows participation in organized activities improves mental and physical health.

Tami Silverman - president and CEO of the Indiana Youth Institute - said the settings foster belonging, confidence, and resilience, reducing feelings of isolation, and promoting positive peer relationships.

"We know that social isolation is on the rise - and so, we're looking at that social isolation going up," said Silverman, "and also, the need for kids to belong. And say, 'What can we do about it? How do we counterbalance that?'"

Silverman said these activities can create safe spaces for youth to set goals, face challenges, and grow.

She added that they provide critical networks of supportive adults, especially for those lacking consistent guidance at home or school.

Silverman said physical activity through team sports improves fitness and lowers risks of obesity and related health issues.

Structured programs also help kids manage stress, avoid risky behaviors, and build a foundation for lifelong success.

Research links extracurricular participation to higher grades, better attendance, and greater college enrollment rates.

"Research, particularly from Child Trends, that talks about those activities build skills such as teamwork, communication, conflict resolution," said Silverman. "I mean, you can see how those skills could go right back into the classroom."

Advocates say addressing barriers like cost, transportation, and availability is essential to ensuring all children can participate.

They say more resources for youth programs can help Indiana create more inclusive and supportive environments.




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Incarcerated young people in Washington state can spend a longer time in detention if they do not have a place to go upon release.

Some of the reasons for longer stays for people under the age of 18 include youth who are experiencing homelessness or are in between homeless shelters.

Sara Zier, director of legal services for TeamChild, a Washington state based advocacy group for youth involved with the juvenile justice system, said overstaying in detention is devastating for the youth who experience it.

"They're facing layers of challenges," Zier pointed out. "Not only do they not have a safe place to sleep or to go home to or a family and supportive adults to meet their needs, but then they're held in detention where they're isolated and they don't have a chance of those things either."

Zier noted many barriers exist to ensuring young people have a place to go when they're released. She explained people do not have a right to determine where they reside until they're 18 years old. A U.S. Supreme Court decision earlier this year allows cities to pass laws punishing people experiencing homelessness, which could exacerbate the situation for young people in Washington.

Degale Cooper, CEO of YouthCare, an organization working to end youth homelessness in King County, said Black, Indigenous and people of color disproportionately experience homelessness in the county. Cooper acknowledged the city of Seattle and the state have policies in place to end youth homelessness, but funding remains an issue.

"Young people are homeless all over our state," Cooper emphasized. "If we don't have the financial resources to support organizations that can house these young people for either short periods of time or long periods of time, then the policy can't work."

State lawmakers passed a measure that went into effect in 2021 stating, "Any unaccompanied youth discharged from a publicly funded system of care will be discharged into safe and stable housing." However, the state has yet to achieve it. Zier stressed it is important to solve the issue of unaccompanied youth held in detention even though population-wise, it is a small number of people.

"From an equity perspective it's really important that our state stick to commitments we've made to house young people," Zier contended. "And also to give young people who are detained for offenses opportunities to engage in treatment, instead of being held in detention where their needs aren't met."

TeamChild offered some recommendations for addressing the issue of youth who are stuck in detention. It said the state should allow faster access to court for young people in detention and adjust the legal emancipation and minor guardianships to better serve people under age 18.