RALEIGH, N.C. - North Carolina has numerous programs that aim to improve the lives of children and their families living in poverty, but how do you quantify the difference the programs make?

A report released today by the Annie E. Casey Foundation. "Measuring Access to Opportunity in the United States," demonstrates that without interventions the state's child poverty rate would be more than double from 17 to 35 percent.

Laila Bell, director of research and data for NC Child, says the value in the report is an understanding of how programs can enact change in the lives of children.

"What it's really showing us is we have the tools that can really help make sure we are keeping kids out of poverty and really helping to avoid some of those preventable long term costs," Bell says.

Today's report uses the Supplemental Poverty Measure (SPM)developed by the U.S. Census, which Bell says provides a more complete picture of how families fare, when compared to the current method of measuring the impact of programs.

According to the nonpartisan NC Child, recent changes to the state's child care subsidy program represent one example of how recent policy decisions in the state are making it difficult for families living in poverty to get ahead or even survive.

The current method used to measure poverty was developed in the 1960s, and according to the U.S. Census sets a standard of $24,000 a year for a family of four, regardless of where that family lives or accounting for inflation.

Laura Speer, associate director for policy reform and advocacy with the Annie E. Casey Foundation, explains better measurement tools, such as the SPM, help make improvements in public programs.

"Using the Supplemental Poverty Measure we can really see the successes and the limitations of the safety net resources that we've put into place," says Speer. "We can also see these resources don't go far enough. We still see there are 13 million children below the poverty line."

The SPM takes into account living costs such as medicine, housing, food and utilities and how those costs affect disposable income. It also accounts for how government programs such as SNAP help offset those costs. Bell says gaining a better picture of poverty in North Carolina helps to improve the economic future of the entire state.

"We know children really do their best when they live in financially secure families, and we all shoulder the burden when our children don't have the opportunity to grow up and become productive citizens and members of our community," says Bell.

The Annie E. Casey report recommends state and federal governments expand access to early childhood education, change tax credit policies to keep more money in the hands of struggling families, and streamline food and housing subsidies.


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As pandemic-era protections were lifted a new report showed the number of children on Medicaid has varied widely between states, with Maryland doing better than most.

The Georgetown University report said nationwide, more than 4 million fewer children were enrolled in Medicaid and the Children's Health Insurance Program at the end of last year compared to spring 2023, before the expiration of continuous coverage. The report estimated in 70% of cases, children's coverage was canceled for procedural reasons such as difficulty navigating the state's website, reaching a person via a help line, or not receiving renewal notices.

Joan Alker, executive director of the Georgetown University Center for Children and Families and the study's co-author, said states need to improve outreach to help avoid disenrollment because of red-tape reasons rather than being ineligible.

"Some states chose to go very slowly and carefully and redo their entire eligibility system so that it worked better," Alker acknowledged. "But other states really doubled down and they moved very quickly to disenroll children, even though many of them likely remain eligible."

In Maryland, the number of kids with coverage declined 3% or nearly 20,000.

The Maryland Children's Health Program offers free as well as low-cost health insurance coverage for children under 19, and income eligibility for children is much higher than for adults. The report noted new programs in some states are offering multiyear continuous coverage to young children.

"A significant number of states are making a shift in their policy to offer continuous coverage for young children," Alker pointed out. "In most cases, from birth to age 6, in a few cases to age 3 or 5. And this is a really terrific breakthrough."

Maryland is not among the 12 states to develop a multiyear coverage program but the District of Columbia has.

Medi-Cal has dropped several hundred thousand low-income children from the health insurance rolls since April 2023, according to a new report from Georgetown University.

The data show a net drop in children's Medi-Cal enrollment of 200,000 kids between April and December of last year, as the state started redetermining participants' annual eligibility - which had been paused to ensure continuous coverage during the pandemic.

Mayra Alvarez, president of the Children's Partnership, said another 100,000 have been dropped this year.

"Some 80% of the people that lose coverage in California are losing it for procedural reasons," said Alvarez, "not because they're not eligible but because their paperwork didn't make it to the county, or they waited too long on the line and got frustrated and had to hang up, or they moved and the letter never even reached them."

The state of California has made a massive outreach effort to keep those who are eligible covered.

More than half a million children, half of California's kids, depend on Medi-Cal. And three quarters of them are children of color.

It is unclear how many kids who lost Medi-Cal were later enrolled in private coverage.

Joan Alker is a co-author of the report, and executive director of the Center for Children and Families at Georgetown University. She said gaps in coverage can lead to long-term negative impacts.

"Kids are going to miss out on those well-child visits, they're going to miss out on getting the medications they need," said Alker, "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."

A few years ago, California lawmakers passed a requirement for continuous coverage in Medi-Cal for children ages zero to five.

Alvarez said she is urging them to follow through and allocate $10 million in the next state budget to fulfill this mission.

After Texas, a new report shows Florida has seen the second-largest decline in the number of children enrolled in Medicaid and the Children's Health Insurance Program.

Of the 4.16 million fewer children enrolled in Medicaid and CHIP nationally, Florida accounts for nearly 600,000 enrollment declines - according to a report by Georgetown University's Center for Children and Families, tracking the Medicaid unwinding since COVID-related coverage protections were lifted.

Alison Yager, executive director with the Florida Health Justice Project, said it's more like a crisis has been unfolding in Florida - and they've long been sounding the alarm.

"This, at its most extreme, can be a question of life or death, really," said Yager, "and short of that, we're seeing far too many families having to now scramble to figure out what's going to change in their monthly budget so they can now pay for whatever medication their kids require."

Yager cautioned that even if families qualify for one of Florida's KidCare programs, there are gaps in coverage.

Going without insurance, even briefly, can cause people to delay seeking care and leave them financially vulnerable when they do.

In February, the state sued the Center for Medicaid Services to stop them from enforcing 12 month continuous eligibility in the state's CHIP program.

The report is based on administrative data from the states to the Centers for Medicare and Medicaid Services.

Joan Alker - executive director of the Center for Children and Families at Georgetown - said Texas, Florida, Georgia and California accounted for half of the total national decline in kids with health insurance.

"This is a real crisis in these states for families whose children rely on Medicaid, but also for the providers that serve them - pediatricians and clinics," said Alker. "The system is really getting shaken up."

An April survey by KFF reveals that almost one fourth of adults who were removed from Medicaid - the program for low-income individuals - after pandemic-related protections ended last spring, now report being uninsured.