La lista de verificación para el regreso a clases de los padres en Arizona podría incluir una doble comprobación para asegurar que sus hijos siguen teniendo seguro médico.

Arizona fue uno de los primeros estados en empezar a comprobar el estado de elegibilidad de todas las personas que recibían cobertura de Medicaid cuando terminó la emergencia de salud pública de la pandemia.

El Director de Políticas de Salud de Children's Action Alliance, Matt Jewett, afirma que desde abril la inscripción en Medicaid en Arizona ya ha disminuido en varios cientos de miles, lo que califica de "preocupante".

Jewett dice que los niños están entre los que están siendo dados de baja de la cobertura, muchos por razones tan simples como errores de archivo, o porque las familias no actualizaron su información de contacto, y conseguir un nuevo seguro puede ser un desafío.

"Gran parte de la población que estamos viendo son esos niños que están superando la edad de KidsCare," señala Jewett, "también estamos viendo personas en zonas rurales que pueden no tener tantas organizaciones que presten ayuda. También estamos viendo que en las zonas tribales, hay mucha gente en situación de riesgo."

Jewett añade que el programa estatal de Medicaid para niños, llamado KidsCare, aumentará la elegibilidad de ingresos de 200% del Nivel Federal de Pobreza, a 225% este otoño. Eso debería significar que un adicional de 12,000 niños podrían inscribirse para la cobertura.

Joan Alker, del Centro para Niños y Familias de la Universidad de Georgetown, dice que es preocupante que muchas de las pérdidas de Medicaid no se deban a que un estado determine que alguien no es elegible, sino a que muchos no han pasado por el proceso de renovación.

Ella dice que si su hijo ha perdido la cobertura de Medicaid, hay una buena probabilidad de que siga siendo elegible.

"Nos encontramos en una situación histórica sin precedentes, en la que los estados, que por lo general carecen de personal suficiente, tienen que procesar las comprobaciones de elegibilidad de todos los que participan en el programa," asegura Alker. "Y eso incluye a la mitad de los niños del país, así que es una tarea enorme."

Alker afirma que las brechas en la cobertura son un problema, sin importar cuánto duren. Añade que, aunque la cobertura de los niños no es cara, son lo que ella denomina "usuarios regulares de atención", y no quiere que las familias se presenten en una farmacia o consultorio médico y sean rechazadas.

The need for child care and early learning is critical, especially in rural Arkansas. One nonprofit is working to fill those gaps by giving providers a chance to get more education.

The Career Pathways Program with Save the Children partners with universities to grow the workforce of child care and preschool providers.

Joyce Taylor, Eastern Arkansas parent-family community engagement coordinator for Save the Children, had more than 20 years' experience with Head Start and said the program gave her the opportunity to pursue a bachelor's degree. It also provides her with resources she can use, in the classroom and with families.

"In particular, we have a family with a child that is autistic," Taylor noted. "Mom is working with the child at home. So I have things that I can share with that family, so she can continue to work with her child."

More than 153,000 openings for child care workers are projected over the next decade, largely driven by the need to replace those who have left the field or retired, according to the Bureau of Labor Statistics.

Taylor pointed out some children have challenging behaviors, and may have a lot of things going on at home. It is her job to help them thrive in preschool.

"Because we're the first start, when they come into Head Start, that's their first opportunity to be in a learning environment," Taylor explained. "It's up to us to do everything that we can do, to help make that first experience successful."

Karen Harrison, managing director of career in education workforce development for Save the Children, said rural areas have access to fewer resources compared to urban areas, so the program focuses on addressing the specific gaps in rural communities. She added the Pathways program aims to reduce barriers to obtaining a higher-ed credential or degree.

"All of our pathways come with incentives," Harrison emphasized. "We either pay all or partial of their tuition; we pay stipends, for books, supplies and materials. We also give 'barrier reduction' stipends. We know that child care for participants themselves can be an issue; transportation, technology needs."

Harrison added the pathway begins with a Child Development Associate credential, followed by an associate degree, and ultimately a bachelor's degree. In the process, they improve the career opportunities for workers, as well as the quality of early learning.

A persistent child care worker shortage across New Hampshire is leaving families with few options.

The state is currently short more than 7,000 child care positions but low wages and burnout are driving workers from the field and forcing some centers to close.

Shannon Tremblay, director of the New Hampshire Child Care Advisory Council, said workers are struggling to care for their own families with wages barely above the federal poverty line.

"No one wants to come in for a low wage," Tremblay pointed out. "No one wants to come in making $15 an hour, working long hours in a stressful environment."

Tremblay argued greater state investment will create long-term benefits for both parents and children, some of whom may have disabilities or behavioral issues which could be identified earlier by trained child care staff.

Last year, state lawmakers invested more than $60 million in child care services, including $15 million for the creation of child care workforce grants and investments in the state's Family Resource Centers.

Tremblay emphasized the end of career and technical education programs in New Hampshire high schools broke the pipeline of workers entering the field, putting greater pressure on current staff to do it all.

"Our providers are the case manager, the cook, the plumber," Tremblay observed. "They want to provide that high-quality care and right now it's just, they can't do it."

Tremblay stressed pandemic-era funding to support the child care industry will run out in September, so state lawmakers need to act. She added the state could increase wages so the burden does not fall on New Hampshire families, who currently spend roughly $24,000 a year on care for two children under age five.

The child welfare system in Pennsylvania faces a staffing crisis affecting children and families throughout the system.

The Child Welfare Resource Center said about 30 counties report caseworker vacancy rates of 30% or higher

Terry Clark, president and CEO of the Pennsylvania Council of Children, Youth and Family Services, at a state Senate hearing on child welfare, challenged the Departments of Education and Human Services to work together to develop a STEM-focused model for human services. It could offer young people opportunities for training, apprenticeships and careers in child welfare, juvenile justice and behavioral health.

"We spend a lot of time focusing on colleges and universities," Clark noted. "But we believe we might want to back this up a little bit, and start looking at middle schools and high schools. Try to reinvigorate, get younger students motivated and trying to come into this field."

Clark pointed out some agencies have asked supervisors and even people from other departments to take on casework responsibilities. A recent Philadelphia study found Community Umbrella Agencies had an average 45% turnover rate, with vacancies ranging from 21-60 positions.

Clark observed private providers face workforce challenges similar to the county child welfare agencies. He emphasized counties are beginning to explore more contractual relationships with private providers for needed work.

"Counties are starting to put out RFPs, calls for private providers to help supplement their workforce," Clark stressed. "That means they're asking private providers to take on roles and functions that, in the past, were primarily done by counties themselves."

Clark argued competitive wages are seen as crucial to attract and retain child welfare workers, and county funding often falls short. He added student loan forgiveness and fellowship programs may be promising ways to bring new people into the field, but lawmakers would have to agree.

"There have been House bills and different Senate bills that have been introduced, or at least in draft form over the years," Clark acknowledged. "We hope that there's continued discussion about those, because if we can get some movement on those, we think those will really help."

He told legislators the turnover trends will not change significantly without increased investment in workers.