SIOUX FALLS, S.D. -- Despite a pre-pandemic period of economic stability, the number of South Dakota children lacking health coverage spiked between 2016 and 2019.

And amid the COVID-19 crisis, a new report raises concerns about the situation worsening.

The latest findings from the Georgetown University Center for Children and Families show South Dakota's rate of uninsured children skyrocketed by more than 60%, the largest increase in the nation.

Xanna Burg, KIDS COUNT coordinator for South Dakota, said because this data is pre-pandemic, they don't know how many more families have lost coverage. But she added there's real concern the number is growing.

"We do know that families are struggling," Burg asserted. "You know people are losing their jobs and with it, the health insurance that came with those jobs. "

Prior to the increase, the rate of uninsured children in South Dakota had fallen to its lowest level.

The report cites constant changes to the Affordable Care Act and more red tape in various states as possible factors for rate spikes.

The data comes as some groups call for a Medicaid expansion in South Dakota. Petitions will soon be circulated for a ballot question in 2022.

Joan Alker, executive director of the Georgetown Center for Children and Families, pointed to the Trump administration's efforts to dismantle the Affordable Care Act.

She said a key factor has been eliminating most of the funding for outreach and "navigators" to help people enroll.

"Families have been getting negative messages that coverage is going away at the same time that community-based resources to help them find public coverage have shrunk," Alker contended.

Burg said that's why a Medicaid expansion, and enhanced outreach from the state for initiatives like the Children's Health Insurance Program, might help stem the tide of children and families going without coverage.

"South Dakota should double down on outreach to families who are eligible but not enrolled in Medicaid or CHIP, particularly during the pandemic when we know more families are struggling," Burg urged.

The report's authors say states have a lot of power to help reverse the situation.

According to the Centers for Medicare and Medicaid Services, South Dakota hasn't adopted any of the targeted strategies designed to boost enrollment in Medicaid and the Children's Health Insurance Program.

Iowa has released an interactive website to help parents find real-time child care options for their kids.

Iowa Child Care Connect, which the state has nicknamed "C3," uses crowdsourcing technology, helping people use up-to-the-minute data to find child care where and when they need it.

Sheila Hansen, senior policy advocate for the nonprofit Common Good Iowa, said C3 is a vast improvement over what the state had before.

"It was kind of clunky and it wasn't really very fast," Hansen recounted. "Hopefully this will be a vast improvement upon that and families will be able to just go in there and immediately find openings in their area."

The site also offers information on subsidies the providers accept along with current real-time openings and quality ratings. Hansen argued the state should focus on improving pay and working conditions for child care workers.

She acknowledged while the technology is a step forward, Common Good Iowa and other advocates said the state does not need more brick-and-mortar child care centers. It needs more staff, which has been the real challenge.

"That's because they're just unable to find the people who want to work in child care because the pay is so low or the benefits aren't there," Hansen explained.

The Iowa Department of Health and Human Services requires child care providers to complete various training requirements and update their certification every two years.


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The deadline is approaching for families to apply for food benefits in Washington state.

The national program known as SUN Bucks is the U-S Department of Agriculture's summer EBT program, which was created during the pandemic and made permanent this year. Most families were automatically eligible for the program, which provides a one-time payment of $120 per child in a household. Families who did not receive the benefit and believe they are eligible can apply through Saturday.

Norah West, assistant director of the Office of Communications and Government Affairs for the Washington State Department of Social and Health Services, said many students get meals through school.

"Having kids be out of school during the summer months makes it a little harder to get access to that nutritious food, and the price of groceries are not going down," West pointed out. "We're pleased to be able to offer even a small amount of assistance to folks."

Kids were automatically enrolled in the program if they are at a school in the National School Lunch Program and qualified with a meal application or Family Income Survey, or they're between age eight and 18 and in a house qualifying for benefits like the Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families.

Families meeting the National School Lunch Program's income eligibility guidelines for free or reduced-price meals can apply for SUN Bucks. In Washington state, more than 580,000 kids have received benefits this summer, totaling nearly $69 million. West noted the USDA has other summer meal programs as well.

"The federal government also offers two other programs called Sun Meals and Sun Meals to Go through school districts, and those are on site meal programs or in some rural areas," West outlined. "People may have the option to go to a site and pick up food and take it with them."

This summer, 37 states chose to participate in the SUN Bucks program.


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As Pennsylvania children return to school, health advocates stress the importance of keeping them insured.

The 2023 State of Children's Health in Pennsylvania report found more than 145,000 children are without health insurance.

Becky Ludwick, vice president of public policy at the Pennsylvania Partnerships for Children, said the back-to-school season is an ideal time to raise awareness among parents in Pennsylvania about free and low-cost public health insurance options. She added many children lost Medicaid coverage during unwinding but some have transitioned to the Children's Health Insurance Program.

"There's an increasing number of kids going without health insurance or have lost health insurance over the past year," Ludwick reported. "We just really want to take this time as kids are gearing up to get back into school again, to remind parents on what they can do to get their kids insured. So we're looking really at Medicaid and the Children's Health Insurance Program."

According to Children's Health Insurance Program guidelines, a family of three earning $60,000 annually can enroll in the program for an average monthly premium of $58 per child, with additional copays as needed. No family earns too much to apply.

Ludwick pointed out the American Academy of Pediatrics emphasizes the importance of back-to-school checkups, including routine vaccinations. She stressed enrollment in Medicaid and CHIP is open year-round and recommended parents contact the programs to ensure their children have comprehensive coverage for their health needs.

"We would encourage the families to reach out as quickly as possible on getting their child enrolled through Medicaid or CHIP," Ludwick stated. "In order to get that coverage, to make sure that they are then covered for their yearly physicals, immunization. That also covers mental health services and dental."

Ludwick pointed out recent measles outbreaks have highlighted declining vaccination rates, particularly for the MMR vaccine, which is putting communities at risk. Vaccination coverage among kindergartners in Pennsylvania has declined gradually, with the latest data showing a drop below 95% for the first time in six years.