A new report from Georgetown University's Center for Children and Families says nationwide, 4.16 million fewer children were enrolled in Medicaid and the Children's Health Insurance Program.

The report tracks the impacts of lifting COVID-19 coverage protections on Medicaid enrollment, showing that Tennessee experienced more than 59,000 disenrollments.

Michele Johnson, executive director of the Tennessee Justice Center, said 76% of people in Tennessee who've lost coverage did so due to procedural reasons, meaning the state doesn't know whether they're eligible or not.

"A couple of weeks ago, we had a two-year-old who had recently had a heart transplant. His family got the packet, they mailed the packet back, and then the response they got back was, 'The income you submitted showed you were over the income.' The two-year-old with a heart transplant got a notice that said, 'Because you never responded to the packet, you're losing coverage,'" she lamented.

Johnson added a persistent issue they are seeing is, the state has been sending Medicaid renewal packets to the wrong addresses, causing families to lose coverage, and continuing the process without fixing the issues.

Johnson said half of children in Tennessee rely on Medicaid for their health coverage. While Tennessee is a low-income state, the Medicaid income eligibility threshold allows many children to qualify for this insurance program, which is crucial for their well-being.

"We know with comprehensive health coverage, children do better as adults, are more likely to finish college, and they're more likely to have jobs as adults that don't require them to ever be on public assistance," Johnson explained. "At least 60,000 children have lost coverage -- and probably more like 100,000 children -- have lost coverage."

Joan Alker, research professor, McCourt School of Public Policy, and executive director of the Georgetown University Center for Children and Families, said they have closely monitored how ending the pandemic's continuous Medicaid coverage policy has affected children's enrollment. She called it a lack of political leadership, since governors are ultimately accountable for administering Medicaid and CHIP programs in their states.

As Alker put it, "States that saw a really large number of children disenrolling, I place that squarely on the governor -- because the folks doing the work needed the resources, they needed the staffing, they needed the procedures and the effort to make this a smoother process than it has been."

Pennsylvania is facing what children's advocacy groups call a historic child care crisis, leaving thousands of young children without access to early learning programs.

A new report estimates Pennsylvania loses $6.65 billion annually when families do not have child care and preschool options.

Kari King, president and CEO of Pennsylvania Partnerships for Children, said the report examines the policies on child care and pre-K, and highlights workforce challenges affecting many families with young children.

"Both in terms of parents and families in the workforce, and the need for child care to be able for parents to work," King outlined. "We know in the report, just over 70% of families with children currently have both parents or caregivers in the workforce."

In his latest budget proposal, Gov. Josh Shapiro addresses some of the workforce challenges with a $17.7 million boost to early childhood education. $15 million is proposed for Pre-K Counts and $2.7 million for Head Start Supplemental Assistance, investments he said are crucial for working parents' economic stability.

King pointed out Pennsylvania child care workers earn just over $15 an hour, or less than many retail jobs, and half of pre-K programs are delivered through child care centers. But some centers struggle to attract and keep qualified staff.

King observed the wage gap leaves some centers with not enough revenue to pay competitive salaries and keep care affordable.

"That's where we've seen there's been quite an impact since the pandemic, with quite a few programs that have actually closed their doors," King noted. "Over 600 child care providers have been lost since right before the pandemic. So, I think you're seeing a lot of those businesses again in that untenable situation."

The report pointed out pre-K teachers in Pennsylvania earn annual salaries about half those of kindergarten teachers. One recommendation is to provide pay for pre-K teachers on a par with elementary school educators.

Advocates for children in New Hampshire said the state needs elected officials who will put kids' futures first.

With biennial budget negotiations to begin next year, they said access to quality early education, school meals and services are all on the line this election.

Megan Brabec, New Hampshire state manager for the Save the Children Action Network, said children cannot vote but they are on the ballot.

"It's really important that we have Senators and representatives that are aware of these issues," Brabec stressed. "That are prioritizing these issues and recognize the role for government in addressing these issues."

Brabec pointed out with child care for two children younger than five now topping $30,000 a year, too many children are forced to go without the early education known to improve their long-term outcomes.

A bipartisan mix of candidates is offering solutions, including the establishment of universal Pre-K to ensure all kids start kindergarten on the same footing. Others want to simplify eligibility for free or reduced-price meals using Medicaid data or create a state fund to finance early educator recruitment and retention.

Ella Bender, a child advocate and student at the University of New Hampshire, has been registering voters and encouraging them to think of future generations.

"We want students to know that the power is in their hands to vote for officials in the state of New Hampshire that are going to put children's needs first," Bender emphasized.

Bender argued every child in New Hampshire deserves a quality education and to have their basic needs met.

A recent Save the Children Action Network survey found a majority of likely voters across the United States feel more favorable about a political candidate who supports greater investments in child care or programs to relieve food insecurity.

A federal pilot program distributing diapers to Massachusetts families in need is expanding.

The program has already distributed more than two million diapers, along with wipes and other supplies, to roughly 2,500 children over the past year.

Melissa White, director of programs for the Valley Opportunity Council in Hampden County, said the program is especially helpful for newly homeless and migrant families.

"It's one less thing you have to think of with all the stressors of, 'I don't even know where I am, so I don't know where to get the diapers, or how to get there, or how I'm going to afford all those things,'" White explained.

White is thrilled federal funds will support the diaper program for another year. More than one-third of Massachusetts families said they cannot afford enough diapers for their children.

Community action agencies distributing the diapers said they are operating at capacity with growing waitlists. Many parents said they cannot leave their infants at child care without providing diapers.

Lisa Smith, executive director of Neighbors in Need in Lawrence, said she has seen the stress it causes for the hundreds of families they serve.

"There is a direct economic correlation that families need diapers so they can go to work, utilize day care," Smith pointed out. "There are so many social and emotional reasons to why this program is important."

Smith noted the diapers help families stretch their dollars a bit further to help meet their basic needs. WIC and SNAP funds cannot be used for diaper purchases.

Advocates hope to make the diaper program permanent in Massachusetts.

Joe Diamond, executive director of the Massachusetts Association for Community Action, a coalition of more than twenty community action agencies, said proposed legislation would create a state diaper fund to improve families' financial security and well-being.

"Our goal is to help people address their fundamental needs," Diamond emphasized. "So they can focus on the kind of training and education that's necessary to continue to get employment or better employment."

Diamond added the association is working with Children's Health Watch in Boston to gather data on the diaper program's effects. Studies show a lack of diapers for their babies as the number one predictor of postpartum depression in new mothers.