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By: Lynanne Gutierrez, President, Groundwork Ohio Follow Lynanne on Twitter and LinkedIn Are you a family who’s struggling to pay the exorbitant cost of child care? Have you quit your job or decided not to work outside the home because you don’t have reliable, affordable child care? Is your business struggling to hire and keep workers because employees can’t find child care? We all pay when children don’t get the priority they need and deserve from state government. The fallout is tremendous and lasting, overwhelming parents and holding back our economy. Child care costs are crushing Ohio families — when they can find it. Ohio workers, on average, spend nearly $10 of every hour worked on child care expenses – and Ohio’s median income is $29 per hour. Infant care averages $11,438 annually. This reality is why we see so many “Help Wanted” signs. It’s why big and small businesses can’t hire and keep people on the job. But failing to invest in high-quality child care and early learning that allows families to work isn’t the only way we’re shortchanging young children. Nearly 65% of all Ohio children start kindergarten behind. If they don’t catch up quickly, they’ll likely stay behind, with learning gaps compounding year over year. They need early educators who are well-trained and fairly compensated so those workers can afford to stay in the profession. On the health front, almost 4 in 10 babies and toddlers from low-income families aren’t getting the necessary preventative care at well-visits. If we don’t intervene early when children have a health issue, the consequences can be life-long and limiting to their potential. Groundwork Ohio is committed to driving up investment in children, especially now, in the wake of the pandemic, which exposed the fragility of systems that support children. We’re helping build a movement that pushes young children to the top of our state’s political agenda, one that holds our leaders accountable for lifting up children and investing in their futures. With the support of families, businesses, and community leaders, we can change things for children. This focus is paying off. Ohio Gov. Mike DeWine’s recent State of the State address was all about what Ohio must do better to ensure children grow up to become healthy, well-educated members of society. We are grateful that he’s using his bully pulpit to advocate for children whose needs too often are overlooked. One of the most important things we at Groundwork Ohio do is create opportunities for the voices of adults who represent children to be heard by policymakers. Children don’t attend town halls or testify before lawmakers. And many of the parents, caregivers, child care providers, health care workers, and small business owners who see the challenges young children face every day cannot participate in the policy process. But we can. And we are doing just that. Over the next 90 days, we’re going on the road for a Listening Tour. We’ll be in 14 communities across the state where we’re inviting families and leaders to come together to share the changes they want, so Ohio can truly and accurately be the best place to be a young child. We hope to see you at one of the upcoming events. Come make your voice and your experiences heard! Learn more and register to attend online. Supporting our youngest children is an investment in them and in Ohio. As Gov. DeWine said in his recent address, “Kids have only one chance to grow up. So, we must have a great sense of urgency, as every moment we waste is a moment they lose.” We owe our youngest our best. As adults, we must speak up for them because they can't speak for themselves. It’s time to take action and hold Ohio leaders accountable.

By Troy Hunter, Director of Research, Evaluation, and Performance, Groundwork Ohio Follow Troy on Twitter and LinkedIn The RAPID Survey Project is a national initiative designed to gather information on the needs and well-being of children under six and the important adults in their lives. We're excited to collaborate with RAPID to implement an ongoing survey of families with young children right here in Ohio. We want to hear from you! If you have at least one child under the age of six, please take our brief, 15-minute survey here. Our objective with RAPID-Ohio is to provide actionable, relevant, and timely data about families' experiences to inform policymakers, advocates, the public, and participants themselves. Together, we will field surveys over the next two years to hear directly from parents on topics like economic security, early learning, maternal and child health, and child well-being, aiming to better understand and address their needs. We hope to engage at least 1,000 Ohio parents in the 15-minute survey available here. Each participant will receive a $5 gift card upon completing the survey, making it a rewarding experience for you as well. The survey will remain open through Thursday, May 2nd. Again, our goal is to reach 1,000 respondents, and we need your help!

By: Kezia Ofosu Atta, Policy Manager, Groundwork Ohio Follow Kezia on LinkedIn Too many Black moms and babies are dying from preventable causes Babies in Ohio bear a disproportionate burden of our failing care systems. In Ohio, infant mortality rates continue to be worse than the U.S. average at 6.9 infant deaths (under age 1) per 1,000 births. Mothers in Ohio also lack adequate access to prenatal care and support. This creates various maternal and infant health disparities across the state. Groundwork Ohio’s Early Childhood Dashboard showed Ohio’s maternal mortality rate in 2019 was 23.8 deaths per 100,000 births. In 2023, the March of Dimes’ Report Card for Ohio showed that 14.4% of birthing mothers in the state received care beginning in the fifth month or later or less than 50% of the appropriate number of visits for the infant’s gestational age. Additionally, nearly 1 in 4 pregnant moms don’t have access to prenatal care in their first trimester. These rates are worse for Black moms and children in Ohio. Black moms in Ohio deserve attention because of the health disparities they experience alongside their babies and families. Some examples: Racial disparities in infant and maternal mortality/morbidity persist regardless of maternal income or education level. Non-Hispanic Black women were more than 2.5 times as likely to die from pregnancy-related causes than non-Hispanic white women. From 2017-2018, excluding deaths due to overdose, the pregnancy-related mortality ratio for non-Hispanic Black individuals per 100,000 live births was 20.9 compared to 13.6 for non-Hispanic white women. Of all pregnancy-related deaths that occurred in Ohio from 2017-2018, 73% of deaths of non-Hispanic Black women were preventable. Ohio has a higher neonatal abstinence rate (11) than the U.S. average of 11 per 1,000 newborns. The infant mortality rate is 2.5 times greater for Black Ohioans than for white Ohioans. Key contributing factors that could have prevented maternal deaths include the provider, support person, or mother’s lack of knowledge or understanding of threats to the health of Black pregnant women. These threats include shortness of breath, which requires immediate care, or the impact of chronic stress due to racism. Raising awareness through Black Maternal Health Week In May 2023, Representatives Juanita Brent (D-Cleveland) and Andrea White (R-Kettering) introduced House Bill 190, which designates the week of April 11 to 17 as Black Maternal Health Week. The bill was created to raise awareness of Black maternal and infant care in Ohio. Since its passage in the Ohio House of Representatives in December 2023, more collaborations have been formed with agents of change to promote Black maternal and infant health. Sadly, HB 190 remains in the Ohio Senate Health Committee. Local communities up their efforts: Mama Certified Earlier this year in Southwest Ohio, Queens Village, Cradle Cincinnati, the Health Collaborative, Mercy Health, the Christ Hospital Health Network, TriHealth, and UC Health came together with bi3, Anthem, and CareSource to establish the Mama Certified website, a collective impact approach to maternal and infant health equity. This website provides visibility into the maternal and infant-related efforts of local hospital networks with a particular focus on better meeting the needs of Black and brown mothers. How it works Mama Certified places the choice of care in mothers' hands. On the website, moms can see rates of maternal, infant, staff, and community care of specific hospitals and whether the hospital is an ally, advocate, or leader in such care. Expectant mothers can also read equity-centered maternal care reports on each hospital which list their performance with a breakdown of their infant and maternal care rates. Each hospital certified by the website receives a grade level for each focus area through points earned from questions asked about their maternal and infant health initiatives. This unprecedented initiative brings inpatient voice into the care delivery process. It also ensures hospital staffs are better trained to support Black and brown mothers and committed to improving workforce diversity to better represent the patients they care for. Kiana Trabue, Vice President of Strategic Partnerships & Chief Program Officer for bi3 said: “Mama Certified is bringing competing health systems together, helping to build trust and transparency in the community by inspiring birthing health systems to work together. Mama Certified has the potential to put Greater Cincinnati at the forefront of positive maternal and infant health outcomes.” Cradle Cincinnati added: “Our local birthing hospitals’ commitment to transparency and their accountability to Black women is groundbreaking. We are deeply grateful for their willingness to work towards maternal health equity. In the end, we want women of all races and ethnicities to have joyful birthing experiences.” Furthermore, “looking back on those initial conversations with moms, it is incredible to see how that seed of an idea has grown into what Mama Certified is today.” The collective hopes that Mama Certified grows into a well-used resource across the state and that more hospitals join forces to meet their goals for Black mothers and infants in Ohio.

By Troy Hunter, Director of Research, Evaluation, and Performance, Groundwork Ohio Follow Troy on Twitter and LinkedIn Governor Mike DeWine showed up as a champion for kids in his recent State of the State address. The announcement of new support for child care affordability and access demonstrates his dedication to Ohio's infants, toddlers, and preschoolers. The initiatives help support the foundations for our youngest Ohioans. Major Supports for Child Care The governor announced two major supports for child care: Child Care Choice Voucher Program: This program will assist over 8,000 Ohio families who earn up to 200% of the federal poverty level, or less than $60,000 for a family of four, with a voucher. This significant step will alleviate the financial burden on working families and provide much-needed relief in accessing quality child care services. Child Care Access Grants: An allocation of $85 million to support licensed early care and education providers, helping them increase capacity, complete repairs, or provide additional support to staff and families, especially those with special needs. Child Care Affordability Child care affordability remains a pressing issue in Ohio. The state ranks last in the nation for child care assistance eligibility, with initial eligibility starting at just 145% of the federal poverty level. The average annual price of child care for an infant is $11,438, which decreases slightly for toddlers ($10,444) and preschoolers ($8,580). These costs are a significant barrier to working families, forcing them to allocate a large portion of their income to child care expenses. Early Care and Education Child Care Choice Program Effective April 29, 2024, working families earning between 146–200% of the federal poverty level will be eligible for the Early Care and Education Child Care Choice Program. An estimated 8,000 families will benefit from this expanded support, which helps to cover child care costs. Family co-payments will be set at 9% and families are eligible for 12 months once approved. To become eligible, families must apply and be denied for the Publicly Funded Child Care program. Once their application is denied due to income, their application for the Child Care Choice Voucher may be processed. Providers will be paid the month following if any eligible child attends at least one day. Only one payment per child will be made in any given month to only one provider. Early Childhood Educators and Programs Are Struggling According to the recent National Association for the Education of Young Children (NAEYC) report We Are NOT OK, Ohio's early childhood education system is experiencing significant strain: 54% of respondents reported at least one child care program in their community closing in the last year. These closures have a profound impact on families by reducing the availability of quality child care options. 46% of respondents indicated they are more burnt out now than a year ago. The demanding nature of the work, coupled with staffing shortages and increased responsibilities, has taken a toll on early childhood educators. 62% of respondents reported that their program was under-enrolled relative to capacity in the past 6 months. This under-enrollment exacerbates financial challenges for programs already operating on tight budgets. New Early Care and Education Access Grants In response to these challenges, the governor's announcement of new grants to support early childhood education programs and expand access to child care in Ohio is timely. The application period is April 12, 2024, to April 26, 2024, and the expense period is July 1, 2023, to August 31, 2024. Licensed early care and education providers may apply to all the grant categories but are eligible to receive a grant in only one. These competitive grants will be awarded to a limited number of programs. Early Care and Education Access Grants Details New Center Start-Up Grant: Increases the number of licensed programs. Maximum amount: $500,000. Program Expansion Grant: Increases the number of children that are able to be cared for in current licensed programs. Maximum amount: $50,000 for centers; $5,000 for family child care. Program Repairs Grant: Maintains or increases the number of spaces available in currently licensed programs. Maximum amount: $100,000 for centers; $5,000 for family child care. Family Child Care Type B to Type A Grant: Increases the number of children able to be served in Family Child Care. Maximum amount: $25,000. Increased Capacity for Children with Special Needs: Increases the number of early care and education programs trained in evidence-based strategies/programs to support the enrollment and development of children with special needs. Maximum amount: $100,000. How to Apply Applications can be submitted through the Ohio Professional Registry, available from April 12, 2024, at 2:00 pm until April 26, 2024, at 5:00 pm. Award notifications will be made on May 3, 2024. Comprehensive guidance, FAQs, and requirements are available on OCCRRA's website. These initiatives are significant strides towards ensuring accessible, affordable, and high-quality child care for Ohio's youngest residents. Groundwork Ohio remains committed to making Ohio the best place to be a young child. We will continue to closely monitor these developments and provide updates on how they impact Ohio's early childhood landscape.

In response to Governor Mike DeWine’s State of the State address, Groundwork Ohio’s CEO Shannon Jones issued the following statement. “Governor DeWine’s address, totally dedicated to the needs of children, underscores his lifelong commitment to kids and echoes the cries of babies, families, and professionals.” Groundwork celebrates Gov. DeWine’s continued and deep commitment to Ohio’s infants, toddlers, and preschoolers, ensuring the economic stability of our state through the strong foundations created for our youngest Ohioans. Today Gov. DeWine made three key new commitments for Ohio’s youngest children: 1. Child Care Choice Voucher Program: 8,000 more Ohio families up to 200% of the federal poverty level, or earning less than $60,000 for a family of four, will be eligible for a voucher. Parents struggle to work with limited access to affordable, quality child care. Over 800,000 working parents have cut back on work due to child care obstacles. “Gov. DeWine has heard the call of working families and now many will have access to a child care voucher.” 2. Child Care Access Grants: $85 million to improve and expand existing child care facilities. Across the state, there are significant facility issues that, at best, undermine the learning of Ohio’s youngest children and, too often, at worst, pose threats to their health or prevent them from being able to access care at all. "Every child deserves access to a safe and nurturing child care environment and this investment is long overdue and a huge step in the right direction.” 3. Family Connects Expansion: New pilot program in 11 Ohio counties where every new mom will be eligible to receive a home visit from a nurse about three weeks after delivering her baby. Gov. DeWine will be asking the legislature to scale Family Connects statewide in the next state budget. "This intervention boosts the health of moms and babies in high-risk communities, addressing disparities and investing in vital infrastructure for their well-being.” The Governor's full State of the State address can be found here.

By Caitlin Feasby, Statewide Coordinator, Ohio Infant-Toddler Court Team Follow Caitlin on LinkedIn Following a 50-state survey, the National Center for Children in Poverty (NCCP) released a Medicaid brief surveying the landscape of infant-early childhood mental health (IECMH) policies across the nation. Medicaid and its companion, the Children’s Health Insurance Program (CHIP), plays a crucial role in assisting low-income families and children by expanding access to healthcare coverage, early screenings, and intervention services essential for identifying, preventing, and treating IECMH concerns. Dispelling the Myth: Many infants and young children have mental health needs A pervasive misconception is that infants and very young children are immune to mental health challenges. This belief suggests that our youngest citizens are beyond the scope of real mental health concerns because they (1) do not retain or recall adverse experiences, and (2) will naturally "grow out" of behavioral challenges. However, evidence contradicts this antiquated belief, revealing that infants and young children prenatally exposed to substances, lacking safe and stable environments, and/or deprived of nurturing caregivers may indeed face adverse outcomes resulting in complex mental health challenges. It is imperative that our systems respond early and adequately to these identified needs with evidence-based and sustainable solutions. Solutions leveraged in other states offers opportunity to improve outcomes in Ohio Nationally, 10 –16 percent of young children experience mental health conditions, with the figure soaring to 22 percent for babies living in poverty. As the primary health and behavioral health care payor for low-income Ohioans, Medicaid is a critical link connecting infants and young children with IECMH services. While the Ohio Department of Medicaid (ODM) has taken steps to improve access to IECMH services—increasing provider rates, in particular— the NCCP survey shows that other states are using some approaches that could help improve outcomes for Ohio’s children. Survey data show that other states are using some approaches that could help improve outcomes for Ohio’s children. IECMH treatment employs a dyadic approach, treating both parent and child together as clinicians work to address the child’s mental and behavioral challenges while helping the parent respond in ways that nurture a healthy child-parent relationship. Although ODM offers reimbursement for dyadic treatment, accessibility is limited to mothers with opioid use disorders and their infants with neonatal abstinence syndrome. ODM neither mandates nor recommends the use of evidence-based models, which could compromise treatment credibility and efficacy. Furthermore, it does not recognize the utilization of the DC:0-5, the primary guide for identifying and diagnosing mental health conditions in infants and young children. Looking Ahead Maternal depression is one of the earliest indicators of IECMH outcomes and low-income women experience postpartum depression at much higher rates. By expanding the reach of depression screenings with standardized tools, we can better connect mothers with timely care to improve their mental wellness. By improving care coordination for babies with complex needs through evidenced-based mental health services, we can strengthen the system serving babies and their caregivers. Although ODM offers some IECMH supports, there are additional strategies that could help address an escalating need for IECMH services in Ohio.

By Danielle Vandegriff, Executive Director/CEO, Ohio Network of Children’s Advocacy Centers As April is Child Abuse Prevention Awareness Month, we see this as a great opportunity to understand the problem in Ohio and what we can all do to make our state a safer place for every child. Originally scheduled as a child prevention week in June of 1982, the United States has been promoting Child Abuse Prevention Month since April of 1983 (1), to highlight community responses to addressing and preventing child abuse while supporting children and families (2). The Ohio Network of Children’s Advocacy Centers (ONCAC) seeks to raise awareness against child abuse this month alongside several crime victim service organizations. To combat the problem of child maltreatment in Ohio, we must first understand the scope of the issue. ONCAC is the statewide association in Ohio that provides support to Ohio’s 37 local Children’s Advocacy Centers (CACs) (3). CACs are trauma-informed child-friendly centers composed of a multi-disciplinary team of professionals that take part in the response to child abuse and neglect including victim advocates, forensic interviewers, medical professionals, mental health professionals, law enforcement, children services, and prosecutors. With all these multidisciplinary partners working together, Children’s Advocacy Centers serve children and families by coordinating the response to child abuse and neglect in a manner that is trauma-informed, evidence-based, and child-focused all while making sure that caregivers and children feel safe, informed, and leave feeling better (4). Children’s Advocacy Centers are an integral part of the response to child abuse. Children’s Advocacy Centers enhance case outcomes and integrate families with services including counseling, case management, medical treatment, and more. Early intervention and prevention programs are pivotal to preventing child sexual abuse. Prevention programming such as bystander intervention, implementation of codes of conduct, and body education for youth can provide children, families, and communities with the resources needed to prevent child abuse from happening. Several Children’s Advocacy Centers throughout Ohio offer prevention programming in their local communities. With child abuse being an adverse childhood experience (ACE), failure to prevent or intervene in abuse can result in negative health outcomes. In 2015, the Health Policy Institute of Ohio found that 21 percent of adults with one ACE and 32 percent of adults with two ACEs were current smokers and that 16 percent of adults with one ACE and 32 percent of adults with two ACEs had experienced depression (5). They also found that non-fatal child maltreatment has an estimated $830,928 in lifetime costs associated, with $760,000 of this cost being related to reduced quality of life. In addition to prevention, Children’s Advocacy Centers can assist with early intervention. Children seen at a Children’s Advocacy Center are anywhere from 1.5-4 times more likely to receive forensic medical exams (6). While abuse can occur at the hands of adults, it can also occur at the hands of other children; with Children’s Advocacy Center treatment, 98 percent of children who hurt another child do not repeat this behavior. Successful child abuse prevention involves everyone: community organizations, educators, professionals, caregivers, and families. Please use the information below to better understand what steps we can take to protect kids. Sources 1 National Children's Alliance. (n.d.). History of national child abuse prevention month. https://www.nationalchildrensalliance.org/wp-content/uploads/2018/03/History-of-National-Child-Abuse-Prevention-Month-1.pdf 2 Child Welfare Information Gateway. (n.d.). About national child abuse prevention month. https://www.childwelfare.gov/preventionmonth/about-national-child-abuse-prevention-month/ 3 Ohio Department of Jobs and Family Services. (n.d.). Child Abuse and Neglect Referrals and Outcomes. https://data.jfs.ohio.gov/dashboards/foster-care-and-adult-protective-services/child-abuse-and-neglect-referrals-and-outcomes 4 NCA. (n.d.). Fact sheet: About NCA and CACs. National Children’s Alliance. 5 Health Policy Institute of Ohio. (2020). Adverse Childhood Experiences (ACEs) Graphics. https://www.healthpolicyohio.org/our-work/facts-figures/adverse-childhood-experiences-aces 6 NCAC. (2019). Efficacy of the child advocacy center model. National Children’s Advocacy Center. https://calio.org/wp-content/uploads/2019/05/efficacy-cac-model.pdf Other Resources Department of Health and Human Services Prevention Resource Guide

By Brittany Boulton, Managing Director of Advocacy and Engagement, Groundwork Ohio Follow Brittany on Twitter and LinkedIn Groundwork Ohio is going on the road, and we want to hear from you! Our team is “hitting the road” this spring, visiting over a dozen of Ohio’s urban and rural communities to listen to and learn from local experts and community leaders as we develop our state policy agenda in preparation for the next state budget cycle and beyond. We are partnering with local organizations doing significant work on behalf of young children in the prenatal through age five space. Through these events, we will engage early childhood experts and professionals, private philanthropy, local government officials, and statewide policy makers. The series will culminate in the creation of a report highlighting the great work happening around the state in support of Ohio’s youngest children, identify opportunities for improvement, and will be shared with state lawmakers and executive branch leaders as a tool to inform state policy. Details on event venues and panel participants are being added to our website daily. You can find updates and register to attend a free event near you here. Please reach out to me directly at bboulton@groundworkohio.org if you would like more information about events from Toledo to Athens, Piqua to Canton, and everywhere in between! We would love to hear about the topics related to young children that interest you, and we will be publishing an on-line survey to receive feedback from those who are unable to make it in person to an event.

By: Shannon Jones, CEO, Groundwork Ohio We work every day to ensure Ohio is the best place to be a young child. But we can’t do it alone. We depend on an army of advocates to use their big voices and speak for young children who can’t speak for themselves. This spring we’re preparing to travel throughout the state, holding community conversations and listening to local experts about early childhood, child care, and maternal health issues affecting Ohioans from all corners of the state. We’ll also be listening closely to Governor DeWine’s State of the State address on Wednesday, April 10 at 12 pm, just three weeks from now, to see how the administration is planning on championing children. In fact, sign up today to receive a customized BINGO card and see if Ohio's infants, toddlers, and young kids come out on top during the speech. Playing BINGO helps us track when the issues of greatest concern to Ohio families are covered. Did you know that 79 percent of Kindergarteners from families with low incomes enter school not ready to learn? Our youngest deserve better and we need to hear more voices in this state asking policymakers for better systems that provide change and create strong foundations for our children and families. Stay tuned and watch for more information from us regarding how you can attend one of our roadshow events and follow along with the State of the State.

As part of our “Get to Know Groundwork” series, we've been spotlighting members of our amazing team. This week, we’re getting to know Susan Ackerman, who joined Groundwork Ohio in March of 2024. In the heart of Groundwork Ohio’s mission stands Susan Ackerman, a passionate and dedicated leader with an unwavering commitment to the well-being of mothers and their precious babies and young children. As the Managing Director of Policy at Groundwork Ohio, Susan brings a lifetime of policy and advocacy expertise to the forefront of our efforts. Susan is the driving force behind the development, leadership, and implementation of the organization’s visionary policy agenda. With a keen focus on critical maternal and infant healthcare initiatives and early learning programs, Susan shapes policies and systems that are not only impactful, but resonate deeply with the needs of Ohio’s infants, toddlers, young children, and their families. In addition to her role in policy development, Susan directs Groundwork Ohio’s statewide coalition efforts, orchestrating recruitment, outreach, engagement, and mobilization initiatives to hold decision-makers accountable to the best interests of Ohio’s youngest. Susan’s journey to Groundwork Ohio is marked by a rich tapestry of experiences, most recently serving as the Managing Director of the Ohio practice for Sellers Dorsey. Here, she collaborated with health systems nationwide, securing additional Medicaid funding to preserve access and enhance care for Medicaid patients—an accomplishment indicative of her commitment to equitable healthcare outcomes. Check out our Q&A with Susan to learn more about why she’s a passionate advocate for young children and families in Ohio. Q: What drew you to early childhood policy research and advocacy? Tell us more about your “why.” A:  I have always been interested in how things connect – in my professional life that means policy and funding. Health and human services policy is especially intricate and intertwined and particularly challenging for many people to navigate. Too often this complexity lets people down rather than helps to lift them up. As the mother of twins. I know that raising children is hard work. I have experienced many of the challenges that Groundwork works to improve - from pregnancy complications to premature birth to challenges finding quality child care – and yet I fully recognize that I had it much easier than most since I had a spouse, financial resources, and extended family support. I feel a strong responsibility to help children thrive. Q: What’s the best piece of advice you’ve received or a lesson that you’ve learned that has helped you in this work? A: I have been fortunate to have a lot of great bosses. Two pieces of advice that stick out are the need to leverage the power of the strong when you serve the poor and the weak and the power of diverse coalitions to make difficult and meaningful change. Q: What’s your word for 2024? A:  Optimism – We all have a vested interest in the health and well-being of children. If we all work together for children, we can improve our collective future. Q: When you aren’t advocating on behalf of young children and families, what do you enjoy doing? A:   With our children about to “leave the payroll,” as they start their post-college lives, my husband and I are reengaging with those activities we set aside when we became parents. Ironically, one of our favorite activities remains checking out our favorite animals at the zoo. I am a huge fan of hippos and capybaras. Q: Describe a scene from your vision of the future for Ohio’s youngest children and their caregivers. A: All Ohio parents are empowered and have the resources that they need to ensure their children thrive. Connect with Susan on Twitter, LinkedIn, or by email.

By: Kezia Ofosu Atta, Policy Assistant and Susan Ackerman, Managing Director, Policy, Groundwork Ohio Follow Kezia and Susan on LinkedIn Janis Fay, a mother of three children with developmental disabilities in Cincinnati, Ohio, vividly describes her ordeal with Ohio's Medicaid unwinding process: "It’s been terrible." In a poignant interview with the Association of Maternal and Child Health Programs in February 2024, she recounted receiving a notification in July 2023 assuring continuous coverage for her children, only to discover later, through their orthodontist, that they were, in fact, uninsured. This abrupt loss of coverage has left her family grappling with the financial burden of managing their children’s complex medical needs, including a daughter diagnosed with autism and a son with scoliosis requiring a back brace they can no longer afford. Janis’s story is all too common; like many families in Ohio, she finds herself in a precarious position—earning too much to qualify for Medicaid but unable to afford adequate health insurance through their employer. After a three-year pause caused by the pandemic, Ohio resumed its Medicaid eligibility determination process in February 2023. Ohio will complete its redetermination process for all enrollees this month. Over the past twelve months, the number of children ages 0 to 6 enrolled in Medicaid has dropped by almost 50,000 children, or 11 percent. At the moment, all we know is that 50,000 young children are no longer enrolled in Medicaid. Some may have gained coverage through their parent’s employer or through the exchange, but many are likely still eligible for Medicaid but and are now uninsured. Unfortunately, this result is not unexpected.  Too often families experience gaps in Medicaid coverage, not because they no longer qualify for coverage, but because they fail to complete the renewal process. This phenomenon, known as program churn, can be particularly harmful to the health and development of young children, as uninsured children are more likely to miss preventive care and developmental screenings. Additionally, Medicaid is often the gateway for enrollment in other supportive services for children, such as WIC, Help Me Grow, and to enrollment in child care. (Children enrolled in child care must submit an annual medical statement from a primary care provider.) Ohio Medicaid Leveraged a Number of Strategies to Reduce Program Churn The Medicaid and CHIP Payment and Access Commission (MACPAC), which advises Congress on Medicaid policy, has assessed churn rates for various eligibility groups with Medicaid. Their study of nationwide data from 2018 found that 18 percent of children enrolled in MAGI3 categories were disenrolled during that year. However, they also found that many of the children who were disenrolled were reenrolled in the program within twelve months. (MAGI is an acronym for Modified Adjusted Gross Income. In layman’s terms this means children who qualify for Medicaid based on their family’s income. The data cited is for children under age 21.) The Ohio Department of Medicaid (ODM) has implemented a number of strategies including increased automation and business process improvements to eliminate the red tape to ensure that eligible enrollees maintain coverage. Many of these strategies that have helped enrollees retain coverage, such as the use of third-party data to inform eligibility and other automations will be ending, but others, such as text messages and robocall reminders to enrollees, will continue. Key Reminders about Medicaid Coverage for Children Children may still be eligible for Medicaid even if their parents are not. Visit Benefits.Ohio.gov or call the Ohio Medicaid hotline at 800-324-8680 for more information. Families may be eligible for subsidized coverage through a marketplace plan. Go to Healthcare.gov for more information. Continuous Medicaid Coverage for Young Children is Coming Any gaps in coverage can delay preventive care, which is particularly concerning for young children as this is a period of rapid development. The American Academy of Pediatrics recommends a schedule of at least twelve well-child visits at specified periods for children by age three. Recognizing the importance of coverage for children, the FY 24-25 budget included continuous coverage for children from birth to age three. While this extension has not yet been implemented, the Ohio Department of Medicaid is currently working on a federal Medicaid 1115 waiver to authorize this provision. Continuous coverage will ensure that children do not have a gap in coverage during a critical stage of their development.

By: Lynanne Gutierrez, President, Groundwork Ohio Follow Lynanne on Twitter and LinkedIn Groundwork Ohio is leading a powerful statewide early childhood movement, securing state policy and investments to meet the growing needs of young children and families. You play a crucial role in this movement, which transcends Ohio's policy landscape and political climate. Our collective effort champions policies with both a long-term strategy and immediate impact. Amidst the noise of constant information, voices, and real needs, we stay focused, strategic, and accountable to our data-driven policy framework, ensuring tangible progress toward our mission and vision. One of the tools we use to hold ourselves accountable to our mission and visions is our Policy Framework. This is a framework for what policies are within the scope of our mission, based on data and evidence. We advance policies that change the factors that result in outcomes that support young children in Ohio who are healthy and ready to learn. When it comes to how we determine policies to advance our mission, Groundwork deploys a robust and adaptable process to craft our policy agenda, uniquely unfolding every two years. This flexibility allows us to respond swiftly to challenges and seize opportunities. The foundation of our progress lies in trusted relationships, nurtured over the past 20 years, propelling remarkable growth and impact. As our advocacy tools and reach expand, our policy process evolves, engaging a broader array of voices through diverse tactics, channels, and platforms. This dynamic approach demands evaluating a wide spectrum of interests and weighing them against opportunities. What does our policy agenda process look like in 2024? Our work timeline aligns with the Ohio General Assembly’s schedule, particularly the state budget process—a pivotal policy and investment opportunity. This year centers on establishing a strong foundation for a successful FY26-27 budget strategy. Leveraging insights from past budget outcomes, challenges, and future opportunities, we draw on our extensive experience to kickstart this process. We're eager to keep you updated on your role in our Policy Agenda process. Currently, our focus is on gathering input from key stakeholders and advocates to assess Ohio's early childhood landscape. Over the next few months, our strategy involves deep community engagement, aiming to connect with as many individuals as possible. This initiative is crucial to inform and energize the movement, especially leading up to the state budget process. The top of our policy process funnel serves as the broadest entry point for your input, providing an open door for your expertise to shape the process and ensure your voice is heard. Get out the map!  How will you ensure your voice shapes our policy agenda? 1. Tune in for Governor DeWine's State of the State address on April 10, 2024, at 12:00 pm. Join us in understanding our state leader's vision and progress assessment, with a keen focus on how it addresses the needs of young children and families. 2. Join us at a Roadshow Listening Tour event in your community between April and June 2024. We're heading your way to hear from you, hosting events with partners across Ohio's urban and rural communities. We're reaching out to diverse audiences, including families, community leaders, early childhood professionals, business leaders, and local and state policymakers. In each community, we'll explore the most significant opportunities and challenges faced by young children and families. Join us at one of 12 events as we aim to engage with over 1,000 individuals. We can't wait to see you there! How will you ensure your voice shapes our policy agenda? 3. Share your experience, work, stories, and data with our team to collaborate on supporting young children and families. Connect with Brittany Boulton, Managing Director of Advocacy & Engagement, or Susan Ackerman, Managing Director of Policy. They'll get you plugged in! 4. Power the movement with your support. Your generous gift ensures the ongoing resources needed to drive our policy agenda process and make a lasting impact. Join us in driving change!