RALEIGH, N.C. -- The importance of Medicaid in small towns and rural parts of North Carolina cannot be overstated, according to a new report from the Georgetown University Center for Children and Families and the North Carolina Rural Health Research Program.

Researchers found that across the nation, a larger percentage of children in rural areas count on Medicaid compared to urban areas - and the Tar Heel State tops that list. Adam Searing, associate professor with Georgetown's McCourt School of Public Policy, explained.

"When you see that number of over half of kids getting Medicaid in these small towns and rural areas, you can really see that any changes to the Medicaid program really do impact, very significantly, small towns and unincorporated areas of the state,” Searing said.

North Carolina is in the top 10 states with the largest difference between the numbers of rural and urban children covered by Medicaid - with 54 percent of rural children on Medicaid, and 39 percent of children in metro counties. The report said the data underscores the importance of preserving funding for Medicaid and related services as Congress debates the American Health Care Act.

Joan Alker, research professor and executive director with the Georgetown University Center for Children and Families, called Medicaid a crucial support for children, families, seniors and people with disabilities.

"Our nation's leaders face a really important decision on whether or not to cut Medicaid and turn their backs on the progress we've made in helping children and families,” Alker said. "That's so important for folks to understand that the Medicaid program is really the backbone of health insurance in these rural areas and small towns."

Searing said another factor contributing to Medicaid's importance in rural communities is that in some cases, it's the only health insurance option in areas where there are fewer opportunities for work.

"There are fewer opportunities and a lot of people working at small businesses that may not offer family health coverage, or even individual coverage,” she said. "They'll have lower incomes, so they may be working at jobs that don't offer coverage at all."

According to the report, the number of children on Medicaid increased by 8 percentage points since 2009.


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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.

Wyoming's suicide rate ranks first in the nation, according to the most recent data, and state lawmakers are taking steps to improve access to mental health care. The state budget recently passed by legislators prioritized ten million dollars for investments in mental health for K-12 students.

Rep. Jon Conrad, R-Evanston, was also able to earmark nearly $11 million for the Wyoming 9-8-8 Suicide and Crisis Lifeline. Conrad said children are more vulnerable now than ever before.

"The challenges that they face - with not only peer pressure, but world events, local events, bullying - have really led us to a point where we are seeing an increase in suicides, unfortunately," he said.

Suicide is the seventh leading cause of death in Wyoming, but it's the second leading cause of death for residents between the age of 10 and 44. Nationally, more than 49,000 people died by suicide in 2022. That's one death every 11 minutes. The Biden administration recently launched a new national suicide prevention plan to address what it calls an urgent and growing public health crisis.

If you or someone you know is in crisis, please call 9-8-8, or text W-Y-O to 741-741.

More than 20% of high school students seriously considered suicide in 2021, and nearly one in ten tried to take their own lives. Conrad was unable to secure $40 million in this year's budget for the 9-8-8 Suicide and Crisis Lifeline, enough to permanently fund the program. Conrad says since August of 2022, the lifeline has answered more than 15,000 calls from Wyomingites.

"And only 2% of those required elevation to the next level, specifically ambulance, or law enforcement, etc. So it is working, the challenge for us and me is to get it to be permanently funded," Conrad said.

Stigma has long been a barrier for people struggling with suicidal thoughts, depression and anxiety disorders, and other mental-health challenges. Conrad believes the prevailing sentiment that individuals should "man up" or "cowboy up" needs to change.

"But you know what, I think manning up and cowboying up is reaching out a hand of fellowship to that person that seems a little distant - whether you like him or not - but someone you see disengaging, and reaching out and saying, 'How can I help?' " Conrad said.


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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."