HARRISBURG, Pa. -- Since the pandemic began, public health coverage for children has increased by 10% in Pennsylvania, and a new report underscored best practices to help ensure that affordable health care is accessible for kids and families.

Becky Ludwick, vice president of public policy at Pennsylvania Partnerships for Children, the group that published the report, said one possible explanation for more kids being insured is Medicaid's "disenrollment freeze," put in place to keep people covered when the federal Public Health Emergency was declared.

Ludwick said it is important to enact more policies to ensure people maintain their coverage.

"One of the simpler things that we're recommending is to ensure that addresses are current for sending renewals," Ludwick explained. "And the reason that's important is because we have been in a public health emergency since March of 2020. And during that time, many individuals may have moved."

Her organization's 2021 State of Children's Health Care report suggests the state also help residents who lose Medicaid coverage to have a smooth transition to other public insurance programs, such as Pennie, the state's health insurance marketplace, or the Children's Health Insurance Program (CHIP).

The report also flagged some of the pandemic's disproportionate impacts on families of color. Black households with children were three times more likely to have lost employment income than white households with children.

Ludwick argued guaranteeing continuous health coverage for all families enrolled in Medicaid is critical to prevent further economic hardship.

"We often see where families have seasonal employment, so their incomes can fluctuate from month to month or from different seasons," Ludwick observed. "And so, even those slight changes in income could potentially leave families at risk of losing their health insurance."

Pennsylvania has continuous eligibility for 12 months for all children in CHIP, and kids under four who are covered through Medicaid.

Many of California's 13.5 million children and teens have not bounced back after the pandemic, especially children of color, according to the just-released 2023 California County Scorecard of Children's Well-Being. The report showcases data from all 58 counties and shows wide disparities in indicators of health, education and more.

Kelly Hardy, senior managing director of health and research at Children Now, said anti-poverty measures during COVID helped a lot, but they were just temporary.

"Thirty-eight percent are in families making less than two times the poverty level, which is around $60,000 a year for a family of four," she said, "so, that's a pretty low bar."

The data show the state has more than 170,000 homeless students, and that the shortage of state-funded child care continues. The report found that in 2017, 2019 and 2021, only one in four working families had access to a space in a licensed child-care facility.

Susannah Kniffen, Children Now's senior managing director of child welfare and government relations, said kids in foster care had alarmingly low scores for access to healthcare and academic achievement.

"These kids are facing distinct challenges that other students aren't," she said, "and they need a very targeted approach to their education if we're ever going to change the numbers, which are fairly dismal."

Vince Stewart, vice president for policy and programs at Children Now, said in terms of education, kids appear to be losing ground as they get older.

"Forty-two percent of third graders met or exceeded standards and reading, 31% of fifth graders met or exceeded standards in science, in 29% of eighth graders met or exceeded standards in math," he said. "And then 11th graders, it's only 27% who are deemed ready for college-level math."

The report does show some bright spots. California children have high rates of health insurance and a high proportion of babies are born at normal birth weight.

Dental hygienists are trying to raise awareness about the importance of oral hygiene, noting dental pain is one of the most common reasons for school absenteeism among children.

Studies show children with dental pain are three times more likely to miss school. In addition, a child or teenager with noticeable dental disorders, such as blackened teeth or tooth loss, can take a negative toll on their self-esteem.

Betty A. Kabel, director of dental outreach for North Florida Medical Centers, sees it all too often, noting for too long, people have treated oral hygiene as a secondary issue instead of a primary concern.

"If a child has a broken arm, they would not be walking around with a broken arm," Kabel pointed out. "Your tooth, if it's an infection, or it's abscess, it's broken, there is a problem, so it's not OK for a kid to be in tooth pain."

Student health is among the top causes for chronic absenteeism, which includes dental pain, vision problems or mental health, according to the Healthy Schools Campaign.

Kabel argued there needs to be more awareness and expanded access for dental care, especially in rural areas.

Kabel stated she hears first-hand from the children she treats who feel embarrassed, and find it difficult to concentrate due to severe pain. She warned there are worse outcomes for untreated dental problems.

"Children die from tooth infections," Kabel stressed. "The infection is right there next to their brain, it's in their bloodstream, so it's a matter of life and death, when you're walking around with an infection in your mouth. "

Florida is among the top states in the nation with individuals living in Dental Health Professional Shortage Areas, and Kabel noted her organization tries to fill the gaps by working with parents and caregivers to try to treat kids who end up in their school nurse's office with severe pain.

She added there are not a lot of providers who see children, so they do their best to get kids into the ones who do provide care to kids.

Knowing how to approach the grief of others can be difficult, although things can get more complicated when addressing the grief of students in school settings.

Estimates indicate that nearly 7% of children in the U.S. will experience the death of a sibling or parent by the age of 18. Overcoming the cultural taboo around dealing with grief is especially important for teachers and other education personnel.

Gilly Cannon, director of the Children's Bereavement Services at Caring Matters in Gaithersburg, said it's important for educators and families to work together to support a grieving child at school.

"If schools were going to do three things," said Cannon, "they need to show that they care about the students, I want them to show that they can listen deeply without judging, and I'd want them to let the student know that school is a safe place for them to be present in, with their grief."

She said listening without judging involves being able to really hear the other person without needing to share your own experience, or making a judgment about the validity of the other person's feelings.

During these conversations people have to deal with their own impulse to want to fix things for the other person, or put a positive spin on the situation. Cannon recommended against both, and said people should begin by acknowledging what's happened.

"Let them know that you've heard that their person has died, and that you are very sad about that news," said Cannon. "So you're showing them that you are acknowledging it, you're aware of it, what you don't want to then do is to try and make them feel better."

Cannon said she believes that educators need to maintain the institutional awareness of the child's experience of loss, and ensure it travels with them during their school years.

"When a child is grieving," said Cannon, "you need to ensure that as they move from class to class and grade to grade and school to school, that you're passing on that information that this child has had a significant loss, because children revisit their grief as they grow. Their grief morphs and changes as they get older and they have milestones without that person."

Cannon also recommended that people avoid well intentioned clichés such as the idea of the deceased person "being in a better place" or that they wouldn't want to see them cry.

She says these kinds of clichés imply that a grieving person should feel better and hold back their tears, but the message communicated to the grieving person is that their feelings are not valid.

"You don't want to diminish any of their feelings," said Cannon. "You want them to be able to say how they're feeling. And also to know that there's no good or bad feelings, there's feelings. There's no judgment on how they're feeling."