WAKE FOREST, N.C. -- Early-childhood educators are finding themselves choosing between basic needs and health care. The median salary for child-care workers in North Carolina is not quite $21,000 - too high to qualify for Medicaid, but leaving many early-childhood educators in the gap.

A new report from one group that advocates for Medicaid expansion in North Carolina interviewed early-childhood educators from across the state, and 1-in-5 said they don’t have health insurance. One educator who asked to be referred to as "Eryka," said she plans her budget very carefully each week for rent, food, electricity, and gas to get to work. But buying private health insurance is far out of reach for her.

She said that means she goes to work even when she’s sick.

"Most of the time, I kind of just have to ride it out and hope I get better. Otherwise, I am going to the ER, wasting their time, or the urgent care, wasting their time, for something small,” Eryka said. “If I had strep throat, I have to go pay $75, $100, to go to urgent care just to get antibiotics. Nothing is easily accessible when you don't have good health insurance."

Two measures in the state Legislature, House Bill 5 and Senate Bill 3, would raise the income level for those eligible for Medicaid. Senate Leader Phil Berger, R-Eden, took aim at provisions in both bills, saying it represents a tax that ultimately will be passed on to patients and taxpayers.

Bills in the House and Senate propose to use federal funding to expand access to Medicaid, as 37 other states already have done. Leaders from both parties and the governor have different approaches to increasing access to health care, but would need to reach a compromise in order to actually pass legislation this session.

Statewide, it's estimated that 500,000 people are in the "coverage gap," earning too much for Medicaid. Among them are thousands of early-childhood educators such as Meranda who said that while she enjoys working with toddlers, the fact that she's been uninsured for more than a year is frustrating.

"If they expanded Medicare, it would be such a huge burden lifted off,” Meranda said. “Then I wouldn't have to worry about getting sick and how long I am going to stay sick for. Am I going to get OK, or is this something serious because I have cancer that runs in my family. All four of my grandparents had it, my great-grandparents had it, my mother had it."

Members of the Early Childhood Advisory Council appointed by Gov. Roy Cooper wrote to legislators last week to share how expanding Medicaid to close the health-insurance coverage gap can help the state's more than 1 million young children.

Reporting by North Carolina News Connection in association with Media in the Public Interest and funded in part by the Park Foundation.


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More than 300,000 children have been dropped from Medicaid and Peach Care for kids since the pandemic ended.

A report from the Georgetown University Center for Children and Families pinpoints a nationwide trend: More than 4 million kids were left uninsured, soon after the COVID public-health emergency ended.

Georgia ranks third-highest for the number of children who have lost coverage.

Judy Fitzgerald, executive director of Voices for Georgia's Children, said many lost coverage because of procedural reasons rather than eligibility.

"They're not ineligible, but there was missing or incomplete paperwork, or what we know from families is, they felt like they didn't receive the notification, they didn't know," she said. "And so, there are a large number of children who are still eligible."

Fitzgerald said the repercussions of disenrollment can be dire, as when children can't get timely access to health-care services, they're more vulnerable to illnesses and developmental delays. The report also found parents with access to employer-sponsored health plans can't always afford the cost of adding their dependents.

While parents face higher income requirements for Medicaid, many children who lost coverage during the pandemic are still eligible. Fitzgerald said Voices for Georgia's Children is advocating for ways to increase enrollment for children, including a more simplified enrollment process and assistance from state agencies to expedite screening.

"So, we're asking the state to expand the kinds of organizations that could screen kids for eligibility, and enroll them in coverage temporarily while the state processes an official enrollment," she added, "and this is something called presumptive eligibility."

She said programs such as SNAP, and information through the Department of Labor, could be used to facilitate renewals. For families who don't qualify, she said, alternative coverage options are available through the insurance marketplace. Navigators through Georgians for a Healthy Future can help find them.

The Medicaid and Nevada Check Up programs had more than 13,000 fewer children enrolled last year than during the pandemic, according to new research from the Georgetown University Center for Children and Families.

States have been reexamining Medicaid benefits since the pandemic ended, and disenrolling families based on their head-of-household's eligibility. Carissa Pearce, health policy manager for the Children's Advocacy Alliance, said this means some children were also dropped from coverage who are still eligible.

As a result, she said, the Centers for Medicare and Medicaid Services told states to stop disenrolling and ensure they were looking at individual eligibility.

"Meaning that children would be screened separately from their parents, and that was a really important change," Pearce explained. "Specifically in Nevada, every person who had been disenrolled up to that point in August and September of 2023 were reinstated for their coverage, so that they could fix their system and then proceed with disenrollments."

Pearce said Nevada didn't start disenrolling children again until January of this year, giving families more time to check the requirements and submit the documentation to keep their coverage. But from January to February, about 1,500 Nevada children were dropped. She said it's important for families to see if their child is eligible for Nevada Check Up or consider a state marketplace insurance program at nevadahealthlink.com.

Tara Raines, deputy director of the Children's Advocacy Alliance, said her message to families is to not avoid medical appointments if they suspect their child may not be covered. She said there are other programs that families can be directed to, and thinks the state could do more to reach and inform families.

"I think a campaign that lets people know, 'Hey, you were disenrolled from Medicaid, here are your options,' would be incredibly helpful," she said, "and I don't know if that looks like partnering with school districts."

Raines said families' living conditions and circumstances vary in the Silver State. This could mean some may not have a permanent address, but should not mean they go without health coverage.


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More than one million children in Texas no longer have health insurance through Medicaid, despite being eligible for coverage, according to a new report from the Georgetown University Center for Children and Families.

During the COVID-19 pandemic, states were not allowed to cancel coverage - then last year, state health departments were tasked with rechecking the eligibility of Medicaid recipients.

Brittney Taylor-Ross, senior policy analyst with the advocacy group Every Texan, said despite the option to slowly complete the task, Texas chose to do it in one year's time.

"We didn't take up a lot of the flexibilities that were offered, so that was a state choice at the leadership level. We also chose to go through this unwinding process pretty quickly. Other states have paused their process when they've seen that things don't look right," Taylor-Ross said.

The report shows Texas has disenrolled more children than any other state. Anyone who lost coverage must reapply. Taylor-Ross said as of April, the median amount of time to process a new Medicaid application is 95 days. Federal law requires this number to be 45 days or less.

Most families don't realize they no longer have coverage until they go to the doctor's office.

Joan Alker, research professor, McCourt School of Public Policy, and executive director, Georgetown University Center for Children and Families, said the problem affects not only families, but the pediatricians and clinics that treat them.

"Kids are going to miss out on those well-child visits, they're going to miss out on getting the medications they need - be it an inhaler for their asthma or an ADHD medication. And that really sets them back, both in their health and their success in school," she said.

Because of the unwinding, more than 4 million fewer children are enrolled in Medicaid. One out of four of those children lives in Texas.