A new report shows the number of children covered by Medicaid varied widely between states as pandemic-era protections were lifted, with Alaska seeing a decline.

The Georgetown University report says nationwide, more than 4 million fewer children were enrolled in Medicaid and the Children's Health Insurance Program at the end of last year versus spring 2023, before the expiration of continuous coverage. Alaska saw a 9% drop in enrollment.

The report estimates that in 70% of cases, children's coverage was canceled for procedural or 'red tape' reasons, such as difficulty navigating the state's website, reaching a person via a help line, or not receiving renewal notices.

Trevor Storrs, president and CEO, Alaska Children's Trust, said since there haven't been changes in eligibility criteria, procedural cancellations are likely.

"More than likely, we have a significant number of Alaska children who are eligible for Medicaid, but were potentially dropped from the program during the unwinding process. Alaska already had one of the highest rates of uninsured children, and this just adds to it," Storrs explained.

Alaska was one of eight states that disenrolled so many children, it had fewer enrolled than prior to the pandemic.

The Alaska Children's Health Insurance Program, Denali KidCare, offers coverage for kids up to 18, and income eligibility for kids is higher than for adults.

The report notes that 12 states and the District of Columbia have developed multi-year coverage programs, with some states keeping kids enrolled up to age 6. Storrs said in meetings with the state Department of Health, advocates are making the case for keeping kids enrolled.

"One of the things that we're in conversations with them is not making children have to re-enroll every year. So, from zero to six, once qualifying for Medicaid, they stay on; and then from seven to 18, it's every two years versus every year," he continued.

Currently in the state, Medicaid recipients must reapply each year. Medicaid coverage includes checkups, sick visits, immunizations as well as dental and vision care.

Study co-author Joan Alker, with the Georgetown University Center for Children and Families, said gaps in coverage can lead to long-term negative health impacts.

"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," Alker pointed out. "And that really sets them back, both in their health and their success in school."

Medicaid is in the crosshairs, as Republicans in Congress are expected to lay out proposals in May to cut $1.5 trillion from the federal budget, prompting strong opposition from educators.

Around 15 million Californians rely on Medicaid, known here as Medi-Cal, for their health care. However, as Mayra Alvarez, president of the Children's Partnership, noted, the cuts would also deal a devastating blow to schools.

"Medicaid is the third-largest source of funding for K-through-12 public schools to help children have access to routine health screenings, preventive services and physical speech and occupational therapies," she said.

The Trump administration is looking for savings to fund the president's other priorities, including extending his 2017 tax cuts, which primarily benefit the wealthy and corporations. School districts are uneasy because they are legally required to provide accommodations for students with disabilities, regardless of how much the federal government is willing to reimburse.

Sacramento County schools superintendent David Gordon said districts would have to make big cuts across all programs.

"Without those funds, there would be a huge bill," he said, "and school districts would be forced to basically play financial roulette to figure out what do we cut?"

Gordon said his district uses Medi-Cal funds to place mental-health clinicians at each school site, so students with psychological needs get early diagnosis and treatment.

Shana Hazan, a trustee for the San Diego Unified School District, said people don't realize the critical role districts play in providing health-care services.

"Students rely on Medi Cal for things like audiology, mental-health support, nursing and wellness, occupational and physical therapy, home hospital care," she said. "These are really essential for many students with the highest needs."

Online extortion cases involving children have been rapidly increasing in Kentucky and nationwide, and legislation signed into law by Gov. Andy Beshear aims to protect kids from digital abuse. Perpetrators use social media platforms, gaming sites and messaging apps to target youths, posing as peers to coerce victims into sharing explicit photos.

Lorin Payne, Louisville Metro Police Department detective, said many parents are unaware of how easy it is for predators to access children online and the techniques they use to groom children.

"Give a child a phone they have access to, the world essentially, everything online, but now the world has access to your child," she explained.

Payne added that she is receiving around six calls a week from parents or caregivers reporting extortion cases. From October 2021 to March 2023, the FBI says it received more than 13,000 reports of online financial sextortion of minors, primarily boys, that led to at least twenty suicides. Cases of digital child abuse or sextortion can be reported to Kentucky's Child Protection Hotline at 1-877-KY-SAFE1 or through the state's online reporting system at 'reportitky.org.'

Shannon Moody, chief officer of policy and strategy with Kentucky Youth Advocates and the Kosair For Kids Face It Movement, said the bipartisan Senate Bill 73 requires sixth graders receive age-appropriate educational materials on red flags and what to do if sextortion happens to them or a peer.

"It strengthens the current law around making sexual extortion a crime in and of itself, whether it's a misdemeanor or felony, depending on the severity. It also empowers victims by giving some clear legal remedies to seek justice and recover damages," she said.

The Family Nurturing Center in Florence serves 10,000 Kentucky children and families each year.

Jane Herms, president and CEO, said 30% of its teen counseling cases involve sextortion. She says increasing awareness on the issue and emphasizing the importance of having conservations about sextortion with kids is critical to prevention.

"Digital abuse is still child abuse, and it really is emotional terrorism, and it leaves very deep psychological scars. It is trauma for children, and you see the impact," she stressed.

Research shows nearly forty percent of teens and around 23% of nine- to 12-year-olds believe sharing nude images with adults they meet online is common. Kosair has developed resources for kids' Cyber Safety at 'faceitabuse.org/cybersafety.'

Groups working to fight hunger in Iowa say proposed cuts to SNAP benefits would fall squarely on the state's kids, who rely on them for food and other needs.

State lawmakers are considering a measure that would limit what items SNAP recipients could buy.

House File 970 would limit SNAP money to buying so-called "healthy" foods - grains, dairy, meat, eggs, fruits and vegetables, or other items considered necessary for good health.

Food Bank of Iowa's Senior Manager of Food Acquisition and Advocacy Emily Shearer said the change could have a dramatic effect on the one in six Iowa kids who face hunger.

"If there are cuts to SNAP, children will be impacted, seniors will be impacted, those with disabilities will be impacted," said Shearer. "So, the majority of people on SNAP that are able to work are working - it's just not enough to make ends meet."

Backers of the bill say they're guarding against abuse of the program.

If it is approved, the Iowa Department of Health and Human Services would have to request a waiver from the U.S. Department of Agriculture to override the current list of foods and beverages SNAP recipients can currently buy.

A 2016 USDA study found there are very few differences in the buying habits of families using SNAP and those who don't.

Shearer said it's been hard to counter the false claims that low-income Iowans have less healthy eating and buying habits, or that they use their SNAP benefits to buy unhealthy items.

"Nobody's buying tobacco and alcohol with their SNAP benefits. They're just not," Shearer insisted. "But with SNAP restrictions the way they're written currently, they're so vague - there's discussion that something like pasta sauce, or soup or jelly, are those going to be restricted? I don't think anyone would define those as 'junk food.'"

The USDA reports about 130,000 Iowans received SNAP benefits in 2024.