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On the Backs of Children: Medicaid

Voices for Children believes that successful stewardship of our state is not just about looking at where we are today, but thinking about where we want to be tomorrow. Cutting funding to programs that have been extremely beneficial to children is concerning to us. In the first of a series of posts, we will examine the devastating impact that federal cuts to Medicaid will have for Nebraska children.

Consistent and preventative health care gives children the best start to grow up to be healthy and productive adults. Since its implementation over 50 years ago, Medicaid has ensured children in low-income families receive proper health care, including preventative treatments. Children who are covered under Medicaid see improved health outcomes as adults, are more likely to finish high school and graduate from college, and are more likely to be financial stable.

The recently proposed American Health Care Act (AHCA) would fundamentally change the structure of the Medicaid program, which currently ensures that over 160,000 Nebraska children– nearly a third of all children– are on track to become healthy and productive adults. Cost estimates from the nonpartisan Congressional Budget Office estimate Medicaid funding will fall as much as $880 billion in the next decade, a decrease of 25%. As it currently operates, Medicaid is designed to be flexible and respond to economic or demographic changes, providing more funding to a state if their eligible population grows to ensure that those who are eligible receive funding. It also helps states respond more quickly to a crisis as we have seen with the opioid epidemic or the lead poisoning crisis in Flint, Michigan.

74 million low-income Americans currently receive health insurance through Medicaid, and approximately half of those recipients are children. Children’s health insurance coverage has made historic gains in recent years, and is now at an all-time-low in Nebraska, with 94.8% of all children covered last year. In addition to keeping our youngest Nebraskans healthy, Medicaid is extremely cost-effective when compared to private insurance, and per-beneficiary costs have grown more slowly over the years.

The AHCA would implement a per capita cap on Medicaid spending where each state would get a pre-determined amount of funding for Medicaid, making the program much less flexible. This will mean that states with be faced with a tough decision: find extra state funds to fund Medicaid or make significant changes to eligibility and coverage. Considering the budget deficit Nebraska currently faces, it is likely that many current Medicaid recipients would lose coverage. The passage of the AHCA and its provisions concerning Medicaid would take vital health care coverage away from Nebraska’s youngest and most vulnerable citizens.

We believe that children’s health insurance coverage must be a priority, and that Congress should not reform health care on the backs of children. If you share our concerns, we urge you to contact your US Senators and Representative.

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URGENT: Millions of Children Stand to Lose Healthcare in Largest Cost Shift to States in History

Children need health care to grow up to be happy, healthy adults. The American Health Care Act, introduced in the House of Representatives last night, includes alarming provisions that would end Medicaid as we know it, a program that nearly one-third of all Nebraska children rely on for their health care, and result in the rationing of health care for kids through cuts to enrollment, services, provider rates, or some combination of all three.

The bill also will make it harder for children who age out of our foster care system to secure and maintain health insurance until age 26, leaving these vulnerable young adults further behind.

While there were many campaign promises to reform the Affordable Care Act, taking away health care from children, people with disabilities, and seniors in nursing homes as the House bill does was never part of the discussion. Perhaps that is because Congress knows that the public’s appetite for this change is low—2/3 of the public want to see Medicaid remain the way it is rather than adopt the changes contained in the current House proposal.

Call your Congressman today! Let them know that you oppose The American Health Care Act and to keep their hands off Medicaid.

District 1: Representative Jeff Fortenberry (402) 438-1598

District 2: Representative Don Bacon (402) 938-0300

District 3: Representative Adrian Smith (308) 384-3900

Senator Fischer: (402) 441-4600

Senator Sasse: (402) 476-1400

Unsure who your Representative is? Click here to find out.

As a country and a state, we have made tremendous strides in ensuring our youngest citizens have access to the health care they need to get and stay well. The American Health Care Act undermines this work and unnecessarily risks the health and wellness of millions of children in the process. For the sake of Nebraska children and millions of other children across the country, we simply cannot allow this bill to pass.

Call your Congressman today! Tell them they cannot reform healthcare on the backs of our youngest and most vulnerable citizens.

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Voices for Children Testimony on LB 235

Voices for Children Policy Coordinator Kaitlin Reece testified today in support of LB 235, a bill to clarify grant requirements for the Summer Food Service Program. Read her full testimony below.

For a printable version of our testimony, click here.


To: Members of the Education Committee

From: Kaitlin Reece, Policy Coordinator for Economic Stability and Health

RE: LB 235-clarify grant requirements for the Summer Food Service Program


Although it is only January, many of Nebraska students are likely already looking forward to summer break.  For many children in families struggling to make ends meet, however, summer is a time of uncertainty and dread.  Access to regular meals at school either through free or reduced-price school breakfasts or lunches can end abruptly.   The Summer Foods Service Program helps ensure that millions of children living in low-income areas across the country do not go hungry when the school year ends.

Nebraska continues to lag in its participation in summer nutrition programs: there are only 8.5 summer nutrition participants for every 100 participants in the free or reduced-price school meals program.  Not surprisingly then, Nebraska ranked 46th in our level of participation in the Summer Foods Service Program in 2016.[1]   This poor ranking has real consequences for Nebraska’s families: 1 in 7 Nebraska families don’t know where their next meal is coming from.[2]

In 2012, the Nebraska Legislature created a summer nutrition grant program to respond to child hunger in summer months.  The grant program, operated through the Nebraska Department of Education, provides one-time grants to schools, governmental entities such as local health departments, and nonprofits who are seeking to start or expand their summer nutrition program.   The grant program has had some major successes, such as the Food Bank for the Heartland’s mobile canteen whose innovative approach to bring meals to children in their own neighborhood.  However, the program has not reached its full potential due to the current requirement for prorated expenses.  Currently, a would-be sponsor must come up with ¾ of the cost of equipment such as a refrigerator from other sources.  For many nonprofits and government agencies interested in feeding hungry kids in the summer, this just isn’t possible and programs never get off the ground.

LB 235 represents a simple, common sense solution to address artificial barriers and red tape that currently prevent many of Nebraska’s hungry children from accessing nutritious meals during summer months and allows the program created in 2012 to work as intended.

Childhood hunger has a serious and long lasting impact on children’s development and academic performance and has been linked to a variety of adverse outcomes from physiological to behavioral.  Although consistent access to food is related to poverty, research tells us that the two operate independently.  Children in households that are both low-income and food-insecure demonstrate poor outcomes at significantly higher rates than low-income children who did not experience hunger.[3]

Most concerning, particularly in light of our state’s investments in juvenile justice reform over the past few years, research regarding food insecurity in older children demonstrates young adults experiencing hunger often cope by making choices that offer short-term survival but are self-sabotaging in the long-term.  These include failing classes to qualify for summer school (and therefore summer meals), stealing, and engaging in survival sex.  As one young girl stated, “a lot of people are choosing to be in jail rather than be on the street.”[4]

Increased access to summer nutrition programming means fewer kids go hungry while also bringing additional dollars and economic opportunities to Nebraska communities across the state.  Estimates show that if summer nutrition programs reached just 40% of free and reduced-lunch participation during the school year, local communities would see an infusion of resources totaling over $2.8 million in federal reimbursements.[5]

Voices for Children in Nebraska supports LB 235 because of its potential to increase access to nutritious meals for Nebraska’s children by allowing more sponsors or would-be sponsors to apply for the funds to start or expand summer food programs.   We see LB 235 as an important part of addressing childhood hunger in Nebraska, particularly when the school year—and school meals—end.




[1] Food Research and Action Center.  “Hunger Doesn’t Take a Vacation: Summer Nutrition Status Report.”  June 2016.  Available online:  http://www.frac.org/wp-content/uploads/2016_summer_nutrition_report.pdf

[2] Kids Count 2016. Available online at: http://kidscountnebraska.com/juvenile-justice/

[3] Ronald E. Kleinman, et al., “Hunger in Children in the United States: Potential Behavioral and Emotional Correlates,” Pediatrics 101, no. 1 (1998), 4-5.

[4] Susan J. Popkin, Molly M. Scott, and Martha Galvez, “Impossible Choices: Teens and Food Insecurity in America,” Urban Institute and Feeding America, September 2016, http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000914-Impossible-Choices-Teens-and-Food-Insecurity-in-America.pdf, 21.

[5] Voices for Children in Nebraska.  “Food for Thought: School Nutrition for Student Performance.”  2016 Issue Brief.

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Let’s Put Nebraska Kids First

At Voices for Children in Nebraska, we advocate for policies that help make our state the best place to be a kid. Guided by research, we seek to remove barriers to opportunity for all children by engaging the public and elected officials on the issues of child welfare, economic stability, health, and juvenile justice


Regardless of the results of this election, child well-being remains a non-partisan issue. As our state’s greatest resource, children serve as a unifier across the political spectrum. The decisions our leaders make about them impact our collective future. Now that you have voted, we encourage you to reach out to your newly elected officials to find out how they will work to make children a priority. To find your current state senator, click here.

With this in mind, we present our Pro-Kid Policy Plan for the upcoming year. This plan represents our vision for a Nebraska where strong communities allow all children to lead healthy, secure, and fulfilling lives.

Pro-Kid Policy Plan

Voices for Children works to ensure that:

Child Welfare: Children grow up in safe, permanent, and loving homes. An effective child welfare system strengthens families and minimizes trauma through timely and appropriate action.

In October, we testified at an interim study on LR 513 about workforce issues within the child welfare and juvenile justice systems. Next week, we will share information with the Legislature during a hearing on LR 523 about the gap in child protective response for 18 year olds, who have not yet reached Nebraska’s age of majority.

Economic Stability: Families are able to achieve financial security, and children’s basic needs are met. State economic policies support families in trying to build a better future and balance work and family life.

Last month, we collaborated with other community partners on, “The Cost of Being Poor” a panel discussion on small debt lawsuits in Nebraska, and how they disproportionately burden low-income Nebraskans.

On December 7, we invite you to join us for a film screening of The Ordinance, a film highlighting a community’s successful efforts to take on predatory lending practices. This industry often prevents families from achieving financial security. Register for free here.

Health: Children and families have access to affordable, quality physical and behavioral health care. Consistent and preventive health care gives children the best start to grow up to be healthy and productive adults.

We are working to ensure the Children’s Health Insurance Program (CHIP) is re-authorized by Congress and that the over 15,000 Nebraska kids currently eligible for Medicaid or CHIP but not yet enrolled get access to care.

Juvenile Justice: Youth are held accountable for their actions in developmentally appropriate ways that promote community safety and allow them to grow into responsible citizens.

Last month, we testified on LR 514 an interim study to examine the availability of transition services for youth who will leave or have left the juvenile justice system while in an out-of-home placement.

With the Pro-Kid Policy at the core of all that we do, Voices for Children will continue researching and advocating to make Nebraska the best place for everyone to be a kid.

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National School Lunch Week

CC by 2.0 via flickr user USDA.gov

CC by 2.0 via flickr user USDA.gov

This week, we are joining President Obama, schools, communities, and advocates across the nation in celebrating National School Lunch Week. The National School Lunch Program (NSLP) was created 70 years ago as lawmakers recognized that child nutrition, particularly throughout the school day, was a top national priority. Most importantly, the NSLP and its newer counterparts, such as the School Breakfast Program and Summer Food Service Program, provides free or subsidized meals to children from low-income households. School nutrition programs, alongside other federal nutrition assistance programs, are crucial in mitigating the adverse outcomes associated with childhood hunger.

Research and conventional wisdom shows that hunger is a significant barrier to learning and academic performance.[1] There is much to celebrate about the NSLP as an invaluable fixture in Nebraska schools and communities; in SY 2013-14:

  • Nearly 45% of enrolled students eligible for free or reduced-price meals[2]
  • About 90% of students eligible for free or reduced-price meals participating in NSLP[3]
  • Almost 2.5 million lunches served to children from low-income families
  • Nearly $60 million in federal reimbursements for lunches served

The program provides vital enrichment and benefits to schools and local communities at a relatively low cost to the state, with state funds accounting for less than 0.3% of total program funding.[4] Federal reimbursements are higher for free and reduced-price meals served in schools, ensuring that robust meal programs exist in high-poverty schools that already face a number of day-to-day challenges.

The current body of research on childhood hunger suggests that breakfast is a particularly important tool in improving behavior and classroom performance in children.[5] Unfortunately, both the provision of breakfast in schools and student participation in breakfast in Nebraska is one of the lowest in the nation, with only about 40 free and reduced-price eligible students participating in breakfast for every 100 participating in lunch. This represents a major missed opportunity in supporting our classrooms in the state, and in the receipt of nearly $10 million in additional federal reimbursements across the state if the breakfast to lunch ratio increased by three-quarters.

The good news is that there are a number of options available to schools and districts that want to increase breakfast participation for the benefit of their students. The Community Eligibility Provision (CEP), a new federal option, allows certain high-poverty schools to provide universal free breakfast and lunch to all students without collecting school meal applications. Learn more about CEP and find out if your school or district is eligible here.

[1] Howard Taras, “Nutrition and Student Performance at School,” J Sch Health 75, no. 6 (2005):199-213.

[2] Voices for Children in Nebraska, Kids Count in Nebraska Report 2015, 37.

[3] “Table 204.10,” Institute of Education Sciences, National Center for Education Statistics, Digest of Education Statistics.

[4] Kids Count in Nebraska Report 2015, 37.

[5] Katie Adolphus, Clare L. Lawton, and Louise Dye, “The Effects of Breakfast on Behavior and Academic Performance in Children and Adolescents,” Frontiers in Human Neuroscience 7(2013): 425.

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Voices Releases 2016 Vote Kids Candidate Survey

Child policy issues often receive little discussion within campaigns and elections. This is not because candidates and the public do not care about the issues. They do. But child policy issues often do not lend themselves to simple sound bites. They are not considered “hot button” issues that shape many campaigns. The result is that the pressing needs of Nebraska’s children have not been the subject of the type of political discourse required to reach consensus and make meaningful changes.

We developed Vote Kids to elevate that discourse. Vote Kids is based on the belief that raising child policy to greater prominence in elections is a way to re-orient our political process towards common concerns and practical solutions. Through Vote Kids, you will find survey results from our Nebraska legislative candidates. These surveys aim to help cut through the confusion and allow voters to learn more about politicians, their priorities, and the policy decisions they make on behalf of children.

Check out responses from candidates in your district and be a voice for children when you vote on November 8th!

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Back to School: Is Your School a Hunger-Free Zone?

CC by 2.0 via flickr user USDAgov

CC by 2.0 via flickr user USDAgov

August means that it’s back to school season in Nebraska! As students and teachers gear up for a full year of learning in the classroom, we at Voices are turning our attention to an important factor in academic success: proper nutrition.

Research tells us that hunger negatively impacts academic performance, and is linked to health-related absences, increased behavioral issues, and even suspensions. Fortunately, school meals through the National School Lunch and Breakfast Programs have long since proven to be effective and successful in keeping schools well fed and well read. Access to affordable, nutritious, and balanced meals is an important part of ensuring that children are learning in a healthy and supportive school environment.

Since 2014, an exciting option to maximize school meal delivery, the Community Eligibility Provision, has been available to certain schools and districts across the country. The provision allows schools in low-income areas with high-poverty student populations to serve universal lunch and breakfast to students at no cost and without application forms. In the last year, over 18,000 schools with a total enrollment of over 8.5 million children adopted CEP and the results are more than promising.

Administrators from CEP schools report increased meal participation, fewer behavioral incidents and visits to the school nurse, reduced administrative burdens, and increased program quality and viability. The success of CEP is well-known to schools and districts across the country, with 50% of all eligible schools adopting in the most recent school year. Nevertheless, Nebraska has reported one of the lowest take-ups of CEP, with only 8% (9 of 112) of eligible schools adopting CEP last year.

The good news is that there is still time for more students to benefit from CEP! Schools and districts can continue to adopt CEP through the school year, and the Nebraska Department of Education is offering technical assistance to administrators.

Is your school already hunger-free, or could your school be a hunger-free zone? Find your school or district in the most recent notification of eligible schools and districts in the state.

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Nebraska’s Summer Lunch Program Troubles

According to a report released earlier this summer by the Food Research and Action Center (FRAC), Nebraska has fallen to 46th nationally in its participation in the Summer Food Service Program (SFSP). In 2014, nearly 125,000 children in Nebraska under the age of 18 qualify for free and reduced lunch, but only around 8.5% (11,000) participated in Summer lunch programs, which is a 5.5% drop from previous years. The drop in participation seems to overlap with a decline in sites that provide the meals themselves. Summer meal programs are extremely important to children under the poverty line when school lets out, as schools are the main entity that can consistently put food on the table for them. This is an issue that needs to monitored going forward. If participation continues to decline, intervention by either the State or Federal government might be necessary to keep children healthy after the bell has last rung for the school year.

Photo by U.S. Department of Agriculture

Photo by U.S. Department of Agriculture

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2016 KIDS COUNT Data Book: Health

2016 KIDS COUNT: HealthLast month, the Annie E. Casey Foundation released the 2016 KIDS COUNT Data Book – an annual ranking of states on 16 key indicators of child well-being in the areas of Economic Well-being, Education, Health, and Family and Community. In this year’s Data Book, Nebraska received an overall ranking of 9th best state in child well-being. Over the next few weeks Voices for Children will be breaking down the rankings and looking at how we did in each indicator, section by section. We began with our highest ranked area, Economic Well-being and continued with a look at our second best ranked domain, Education. Today we continue our series with the health indicators.

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Reflections on My First Three Weeks at Voices


My name is Rob Wisler and I have been interning at Voices For Children for three weeks. In that time I have worked on multiple projects, each one giving me a look at issues that children in Nebraska face. These issues include lack of health insurance, juvenile justice, and the foster care system.


The Affordable Care Act passed on March 23, 2010 and began to take effect in 2013 when health insurance marketplaces opened and Medicaid expansion started to occur in individual states. The United States estimated percentage of uninsured children age 0-17 fell from 6.6% in 2012 to 5.5% in 2014. That figure varies, however, across the country. In Nebraska the estimated percentage of uninsured children has declined from 6% in 2012 to just 5.6% in 2014. In the 51 smallest counties by population, more than 8% of children under the age of 18 do not have health insurance and the percentage has remained relatively level since 2012. Clearly a gap exists between what the Children’s Health Insurance Program covers in Nebraska and private insurance. The next step needs to be discussing expansion of CHIP, and perhaps Medicaid funding if necessary, to fill this gap. More than 20,000 Nebraska children lacking health insurance is clearly not “the good life” that Nebraskans should be proud of.

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