AUSTIN, Texas – Texas has the highest rate of uninsured women of childbearing age in the nation, with one in four lacking coverage, according to a new report from the Georgetown University Center for Children and Families.

It says states that expanded Medicaid under the Affordable Care Act saw a 50% greater reduction in infant mortality than in non-expansion states.

Laura Guerra-Cardus, deputy director of Children's Defense Fund–Texas, explained that to ensure women have healthy pregnancies and babies, women need health-care coverage throughout their lives.

"States that have expanded Medicaid have seen reduced rates of both maternal deaths and infant mortality. They've reduced health disparities," said Guerra-Cardus. "African-American women are three times as likely to die from childbirth and pregnancy complications."

Texas lawmakers have argued that expanding Medicaid could leave the state on the hook if the Affordable Care Act implodes.

But Guerra-Cardus noted lawmakers are leaving $6 billion a year on the table that could provide health coverage for more than 1 million Texans. She believes the largely partisan opposition to expansion should be put aside to prioritize the lives of women and children.

Joan Alker, executive director of the Georgetown University Center on Children and Families, pointed out that among developed nations, maternal mortality in the United States is going in the wrong direction.

She is convinced that Medicaid expansion is the single most important step states can take to address the crisis, in part because steady, uninterrupted health coverage is critical for healthy birth outcomes.

"Some pretty big states – like Texas, Florida, Georgia – have coverage gaps," Alker said. "And as a result, we see those states that have not expanded Medicaid under the Affordable Care Act, the uninsurance rate for women of childbearing age is nearly twice as high as those states that have expanded Medicaid."

In non-expansion states, many women only get coverage after they find out they're pregnant, which Alker calls problematic when a growing body of research shows that women need to be healthy at the time of conception.

States that expanded Medicaid improved maternal health outcomes by increasing access to preventive care, and also reduced adverse health outcomes before, during and after pregnancies.

The Georgetown report was released in conjunction with the March of Dimes and the American College of Obstetricians and Gynecologists.

After the tragic death of Kyneddi Miller, a 14-year-old West Virginia girl found dead in her home, some state lawmakers are calling on the governor to pass a bill known as "Raylee's Law" during a special session expected in August.

Named after Raylee Browning, an 8-year-old girl who was removed from public school and home-schooled after teachers reported abuse to child protective services, versions of the law have stalled in the Legislature the past few years.

Del. Joey Garcia, D-Fairmont, said the law would ban county school boards from authorizing home-school instruction if there's a pending child abuse or neglect investigation against a parent or guardian.

"I think what we're looking at is there has to be some level of accountability," Garcia contended. "Just like there is in the public school system, that children are being taught, that they're not being abused."

A 2023 analysis by the Washington Post estimated there are 1 million to nearly 3 million home-schooled children in the United States. In West Virginia, the number is around 13,000, according to the West Virginia Home Educators Association, which said it opposes any oversight of home schooling.

Garcia emphasized the law is designed to help improve one aspect of the state's failing child welfare system. In 2019, current and former foster care children filed a class-action lawsuit arguing the state repeatedly failed to protect children in its care. He added West Virginia has work to do when it comes to child safety.

"Across the aisle, Democrats, Republicans, people of all different beliefs with respect to education, to try to provide for a reasonable and narrowly tailored law that protects children," Garcia explained.

Lawmakers also are in discussion with local school boards about enforcing assessment completion for home-schooled kids. State law requires assessments at certain grade levels and local public school officials have few options to check on children when a parent or guardian fails to submit them. Data show just 37% of home-school households submit assessments.


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The high cost of child care in Washington can strain family budgets. It can be even harder when families are experiencing homelessness.

A statewide call center is helping people find care and a way to afford it. BrightSpark Early Learning Services operates the Child Care Aware of Washington Family Center, which fields calls from families.

The center also has homeless navigation services. Erika Washington, department manager of family access with BrightSpark, said staff ensure they understand each families' needs.

"Does your little one have any special needs? And we're really able to pinpoint programs that meet each families unique needs," said Washington. "This offers families some stability and just knowing that we're on their side, we have their back and we're also understanding of some of the challenges that they may face."

Washington said the call center is able to connect families with state child care subsidies like Working Connections, or through the homelessness grace period.

The center also provides follow-up services after 30, 60, and 120 days.

Washington talked about one family BrightSpark was able to help that moved to Washington and ended up needing housing. The family had one school-age child and two kids under the age of five.

Washington said they connected the family with a child care program that understood how to support families experiencing homelessness.

"So when transportation became an issue, or when hours of operation became an issue," said Washington, "this child care provider was able to really support this family's needs and really become more of like a family or support system for that parent."

Washington said the center wants to uplift families' voices and let them know how they can take action. She said they support enough families experiencing homelessness to understand their needs.

"A lot of times those families who are experiencing homelessness are working the evening hours or weekend hours," said Washington, "and that's a big challenge across our state, of being able to find child care programs that is available during those hours. And so, it's something that we hear time and time again, and we often are providing support but that need continues to be there."

Utah parents can expect to pay between $800 and $1,200 dollars a month for child care but a new program is expanding its reach into Summit County to help with affordability.

The nationwide child care network Upwards will offer need-based child care scholarships of up to $1,700 for preschoolers. The group is partnering with Summit County and Park City Municipal.

Starr Mastrodonato, program manager for Upwards, said to qualify, at least one parent must reside or work in Summit County, and the total family income cannot exceed 100% of the county's area median income. She pointed out removing barriers to child care also means parents can stay in the workforce.

"It really allowed them to make life decisions on, 'We both can continue to work and to contribute to our family,'" Mastrodonato explained. "And that obviously is just monumental in just overall well-being, not only for their household, their children. And it continues to help the economic workforce."

While cost is one factor, availability is another. Research shows no one county in Utah has the sufficient number of licensed care providers to meet demand. Summit County has the highest percentage of child care needs being met at 54%, according to Voices for Utah Children. Statewide, the number drops to 36%.

Mastrodonato explained expanding assistance to Summit County comes after their Park City pilot program was able to assist 34 working families and helped support 17 child care providers. For every child enrolled at a provider location, the provider receives an additional $300 per month. She added Upwards is excited to build on the program's success.

"We're hoping they take this model, to see how successful it has been," Mastrodonato noted. "And within six months, be able to identify that we can expand to reach more families."

Summit County scholarships and child care provider incentives became available earlier this month. They will be available on a first-come, first-served basis each month.


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